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Call CC, Hawkins MS, Shah VK, Frank D, Niemi S, Jouppi RJ, Ferguson E, Conlon RPK, Levine MD. A longitudinal investigation of breastfeeding planning, initiation, and duration among individuals with pre-pregnancy overweight or obesity. Appetite 2024; 197:107333. [PMID: 38570117 PMCID: PMC11104448 DOI: 10.1016/j.appet.2024.107333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Individuals with a body mass index (BMI)≥25 kg/m2 are less likely to initiate and continue breastfeeding than are those with BMIs<25. Given the intergenerational health benefits of breastfeeding, it is important to understand breastfeeding behaviors and their correlates among individuals with BMIs≥25. Thus, in an observational cohort with BMI≥25 (N = 237), we aimed to characterize longitudinal relationships among breastfeeding planning, initiation, and duration and their sociodemographic/clinical correlates and determine if pre-pregnancy BMI predicts breastfeeding planning, initiation, and duration. Breastfeeding behaviors, weight/BMI, and sociodemographic/clinical characteristics were assessed in early, mid, and late pregnancy, and at six-months postpartum. Most participants planned to (84%) and initiated (81%) breastfeeding, of which 37% breastfed for ≥6 months. Participants who were married, first-time parents, higher in education/income, and had never smoked tobacco were more likely to plan, initiate, and achieve ≥6 months of breastfeeding. Higher pre-pregnancy BMI was not associated with breastfeeding planning or initiation but was associated with lower adjusted odds of breastfeeding for ≥6 months relative to <6 months. Findings suggest that support aimed at extending breastfeeding among those with elevated pre-pregnancy BMI may be warranted. Future interventions should also address sociodemographic and clinical inequities in breastfeeding.
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Affiliation(s)
- Christine C Call
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Marquis S Hawkins
- University of Pittsburgh, Department of Epidemiology, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Vrusha K Shah
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - David Frank
- University of Pittsburgh, Department of Epidemiology, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Sarah Niemi
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Riley J Jouppi
- University of Pittsburgh, Department of Psychology, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
| | - Emma Ferguson
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Rachel P K Conlon
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Michele D Levine
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA; University of Pittsburgh, Department of Psychology, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
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Keenan-Devlin LS, Smart BP, Hirschhorn L, Meier P, Jefferson U, Solomonides A, Wang CE, Handler A, Silver RK, Borders AEB. Clinically Integrated Breastfeeding Peer Counseling to Promote Breastfeeding Equity. Am J Perinatol 2024; 41:e2313-e2325. [PMID: 37494586 DOI: 10.1055/s-0043-1771255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This study aimed to determine whether clinically integrated Breastfeeding Peer Counseling (ci-BPC) added to usual lactation care reduces disparities in breastfeeding intensity and duration for Black and Hispanic/Latine participants. STUDY DESIGN This study is a pragmatic, randomized control trial (RCT) of ci-BPC care at two ci-BPC-naïve obstetrical hospital facilities in the greater Chicago area. Participants will include 720 patients delivering at Hospital Site 1 and Hospital Site 2 who will be recruited from eight prenatal care sites during midpregnancy. Participants must be English or Spanish speaking, planning to parent their child, and have no exposure to ci-BPC care prior to enrollment. Randomization will be stratified by race and ethnicity to create three analytic groups: Black, Hispanic/Latine, and other races. RESULTS The primary outcome will be breastfeeding duration. Additional outcomes will include the proportion of breastmilk feeds during the delivery admission, at 6-week postdelivery, and at 6-month postdelivery. A process evaluation will be conducted to understand implementation outcomes, facilitators, and barriers to inform replication and scaling of the innovative ci-BPC model. CONCLUSION This research will produce findings of relevance to perinatal patients and their families, the vast majority of whom desire to provide breastmilk to their infants and require support to succeed with their feeding goals. As the largest RCT of ci-BPC in the United States to date, this research will improve the quality of evidence available regarding the effectiveness of ci-BPC at reducing disparities. These findings will help patients and stakeholders determine the benefits of accepting and adopting the program and inform policies focused on improving perinatal care and reducing maternal/child health disparities. This study is registered with Clinical Trial (identifier: NCT05441709). KEY POINTS · Ci-BPC can promote racial breastfeeding equity.. · Ci-BPC has not been tested as a generalized lactation strategy in prior trials and is underused.. · This RCT will identify if ci-BPC can reduce breastfeeding disparities for Black and Hispanic patients..
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Affiliation(s)
- Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Britney P Smart
- Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
| | - Lisa Hirschhorn
- Medical and Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paula Meier
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
| | - Urmeka Jefferson
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
| | | | - Chi Ed Wang
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois
| | - Arden Handler
- Community and Health Sciences, University of Illinois Chicago School of Public Health, Chicago, Illinois
| | - Richard K Silver
- Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Ann E B Borders
- Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
- Institute for Public Health and Medicine, Northwestern University Center for Healthcare Studies, Chicago, Illinois
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Asare AO, Stagg BC, Sharareh N, Stipelman C, Del Fiol G, Smith JD. Vision Loss in Children from Immigrant and Nonimmigrant Households: Evidence from the National Survey of Children's Health 2018-2020. J Immigr Minor Health 2024:10.1007/s10903-024-01597-3. [PMID: 38581597 DOI: 10.1007/s10903-024-01597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
The aim of this study was to determine whether immigrant generation is associated with caregiver-reported vision loss in children adjusting for sociodemographic characteristics. Nationally representative data from the National Survey of Children's Health (2018-2020) was used. The primary exposure was immigrant generation defined as: first (child and all reported parents were born outside the United States); second (child was born in the United States and at least one parent was born outside the United States); third or higher (all parents in the household were born in the United States). The main outcome was caregiver-reported vision loss in child. Adjusted odds ratios (aOR) and 95% confidence intervals were computed based on immigration generation. The study sample included 84,860 US children aged 3-17 years. First generation children had higher adjusted odds of caregiver-reported vision loss (aOR 2.30; 95% CI 1.21, 4.35) than third or higher generation children after adjusting for demographic characteristics and social determinants of health. For Hispanic families, first generation (aOR 2.99; 95% CI 1.34, 6.66), and second-generation children (aOR 1.70; 95% CI 1.06, 2.74) had a higher adjusted odds of vision loss compared with third or higher generation children. Even when adjusting for sociodemographic characteristics, first generation children had greater odds of vision loss, especially in Hispanic households, than third generation children. Immigration generation should be treated as an independent risk factor for vision loss for children and is a social determinant of eye health.
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Affiliation(s)
- Afua O Asare
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA.
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT, 84108, USA.
| | - Brian C Stagg
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT, 84108, USA
| | - Nasser Sharareh
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT, 84108, USA
| | - Carole Stipelman
- Department of Pediatrics, Division of General Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Room 1N410, Salt Lake City, UT, 84108, USA
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Jiang L, Nianogo RA, Prelip M, Wang MC. The role of breastfeeding support in racial/ethnic disparities in breastfeeding practices. Prev Med 2024; 179:107857. [PMID: 38224744 DOI: 10.1016/j.ypmed.2024.107857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Persistent racial/ethnic disparities in breastfeeding practices in the United States are well documented but the underlying causes remain unclear. While racial/ethnic disparities are often intertwined with socioeconomic disparities in breastfeeding, studies suggest that lack of breastfeeding support from family, health care organizations and workplaces may contribute to racial/ethnic disparities in breastfeeding rates. No studies have investigated the extent to which racial/ethnic disparities in breastfeeding practices can be explained by breastfeeding support. METHODS We used survey data from participants of a federal nutrition assistance program in Los Angeles County, the most populous county in the United States, to examine causal mechanisms underlying racial/ethnic disparities in breastfeeding in five groups: Spanish-speaking Latina, English-speaking Latina, Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Non-Hispanic Asian (NHA). Applying causal mediation analysis, this study estimated the proportion of racial/ethnic differences in breastfeeding ('any' breastfeeding, i.e., partial or exclusive) rates at 6 months that could be explained by differential access to breastfeeding support from family, birth hospitals and workplaces. RESULTS NHB and English-speaking Latina mothers were less likely, and Spanish-speaking Latina mothers more likely to breastfeed through 6 months than NHW mothers. Lack of breastfeeding support from family, hospitals and workplaces accounted for approximately 68% of the difference in any breastfeeding rates at 6 months between NHW and NHB mothers and 36% of the difference between NHW and English-speaking Latina mothers. CONCLUSION These findings highlight the importance of improving support from family, hospitals and workplaces for breastfeeding mothers to reduce racial/ethnic disparities in breastfeeding.
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Affiliation(s)
- Linghui Jiang
- Department of Community Health Sciences, University of California, Los Angeles, California, USA..
| | - Roch A Nianogo
- Department of Epidemiology, University of California, Los Angeles, California, USA..
| | - Michael Prelip
- Department of Community Health Sciences, University of California, Los Angeles, California, USA..
| | - May C Wang
- Department of Community Health Sciences, University of California, Los Angeles, California, USA..
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Kopp SJ, Kelly EA, DeFranco EA. Influence of social determinants of health on breastfeeding intent in the United States. Birth 2023; 50:858-867. [PMID: 37395480 DOI: 10.1111/birt.12740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Breastfeeding rates in the United States are suboptimal despite public health recommendations that infants are fed breastmilk for their first year of life. This study aimed to characterize the influence of social determinants of health on intended breastfeeding duration. METHODS This case-control study analyzed breastfeeding intent in 421 postpartum women. Data on social determinants and medical history were obtained from medical records and participant self-report. Logistic regression estimated the influence of demographic factors and social determinants on intent to breastfeed for durations of <6 months, 6-12 months, and at least 1 year. RESULTS Thirty-five percent of mothers intended to breastfeed for at least 6 months, and 15% for 1 year. Social determinants that negatively predicted breastfeeding intent included not owning transportation and living in a dangerous neighborhood (p < 0.05). Women were more likely to intend to breastfeed for 12 months if they had knowledge of breastfeeding recommendations (adjusted odds ratio [aOR] 6.19, 95% confidence interval [CI 2.67-14.34]), an identifiable medical provider (aOR 2.64 [CI 1.22-5.72]), familial support (aOR 2.80 [CI 1.01-7.80]), or were married (aOR 2.55 [CI 1.01-6.46]). Sociodemographic factors that negatively influenced breastfeeding intent included non-Hispanic Black race, no high school diploma, cigarette use, income below $20,000, fewer than five prenatal visits, and WIC or Medicaid enrollment (p < 0.05). CONCLUSIONS Women who lack familial support, an identifiable healthcare provider, or knowledge of breastfeeding guidelines are less likely to intend to breastfeed. Public health initiatives should address these determinants to improve breastfeeding and infant outcomes.
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Affiliation(s)
- Sarah J Kopp
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth A Kelly
- Division of General Obstetrics and Gynecology, Department of Clinical Obstetrics and Gynecology, Women's Community Health Services, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emily A DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Thompson KA, White JP, Bardone-Cone AM. Associations between pressure to breastfeed and depressive, anxiety, obsessive-compulsive, and eating disorder symptoms among postpartum women. Psychiatry Res 2023; 328:115432. [PMID: 37669578 DOI: 10.1016/j.psychres.2023.115432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Data from qualitative interviews indicate postpartum individuals feel pressure from their healthcare providers, the media, and their partners to breastfeed their infant(s). However, the link between pressure to breastfeed and maternal mental health symptoms has not been evaluated quantitatively. The goal of the current study was to evaluate the associations between perceived pressure to breastfeed from various sources and depressive, anxiety, obsessive-compulsive, and eating disorder symptoms among postpartum individuals. METHODS Participants were 306 women, ages 18-39, who gave birth in the past 12 months in the United States (primarily in North Carolina). They completed an online survey about their health history (including mental health symptoms) and breastfeeding experiences. RESULTS Results found postpartum women perceived more pressure to breastfeed from healthcare providers and from the media compared to pressure to breastfeed from their partners. Pressure from healthcare providers was associated with depressive, obsessive-compulsive, and eating disorder symptoms, but not with anxiety symptoms. Pressure from the media was associated with only depressive and eating disorder symptoms. Pressure from partners was not significantly associated with mental health symptoms. Above and beyond the other sources of pressure, pressure from healthcare providers explained a unique proportion of variance of obsessive-compulsive and eating disorder symptoms. LIMITATIONS Limitations include the cross-sectional design (which limits causal interpretations), and the homogenous sample (87% identified as White). CONCLUSIONS Messaging and information about breastfeeding (particularly from healthcare providers) should be reviewed to determine if there is language which could be perceived as "pressure." It is important to screen for a variety of mental health symptoms, including eating disorders, in perinatal populations when discussing breastfeeding.
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Affiliation(s)
- Katherine A Thompson
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Department of Psychology and Neurosciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Jennifer P White
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC, United States
| | - Anna M Bardone-Cone
- Department of Psychology and Neurosciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Kim S, Williams AD. Roles of Income and Acculturation in the Hispanic Paradox: Breastfeeding Among Hispanic Women. Matern Child Health J 2023; 27:1070-1080. [PMID: 36988791 DOI: 10.1007/s10995-023-03643-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Despite Hispanics' high prevalence of breastfeeding compared to other racial/ethnic groups, contributing factors remain unclear. This study examines the complex relationship among Hispanic nativity, acculturation, income, and breastfeeding. METHODS The Fragile Families Child Wellbeing Study baseline (1998-2000) and Year 1 data (1999-2001) were used, including 4,077 women (933 non-Hispanic white, 2,046 non-Hispanic Black, 352 US-born Mexicans [USM], 299 US-born other Hispanics [USH], 302 foreign-born Mexicans [FBM], and 145 foreign-born other Hispanics [FBH]). Logistic regression estimated odds ratios(OR) and 95% confidence intervals(CI) for associations between Hispanic nativity and breastfeeding initiation and 4-month and 6-month breastfeeding, accounting for acculturation (Spanish language use, cultural engagement, religiosity, and traditional gender role attitudes), demographics, income, and health factors. Models were run for the overall sample and stratified by low vs. high income (above median: $21,600). RESULTS FBM(OR:2.35, 95%CI 1.33,4.15) and FBH(OR:2.28, 95%CI 1.23,4.24) had higher odds, while USM(OR:0.55, 95%CI 0.41,0.73) and USH(OR:0.50, 95%CI 0.37,0.67) had lower odds of breastfeeding initiation, compared to white women. USM had lower odds of 4-month(OR:0.53, 95%CI 0.36,0.80) and 6-month breastfeeding(OR:0.38, 95%CI 0.23,0.63), as did USH for 4-month(OR:0.64, 95%CI 0.42,0.99) and 6-month breastfeeding(OR:0.50, 95%CI 0.30,0.85). In stratified models, low-income (vs. high-income) FBH had higher odds of breastfeeding initiation(OR:3.73 95%CI 1.43,9.75) and 4-month(OR:3.01 95%CI 1.12,8.04) and 6-month breastfeeding(OR:3.08 95%CI 1.07,8.88), yet effects of acculturation across income strata are inconsistent. CONCLUSIONS FOR PRACTICE The Hispanic paradox operates differentially due to nativity, income, and acculturation. Breastfeeding intervention and promotion may require tailored approaches to Hispanic subgroups.
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Affiliation(s)
- Soojung Kim
- Department of Communication, University of North Dakota, Columbia Hall, Room 2370, 501 N Columbia Rd. Stop 7169, Grand Forks, ND, 58202-7169, USA
| | - Andrew D Williams
- Public Health Program, Department of Population Health, UND School of Medicine and Health Sciences, University of North Dakota, Room E162, 1301 North Columbia Road Stop 9037, Grand Forks, ND, 58202-9037, USA.
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Zahra L, Kremer P, Bolton KA. A cross-sectional study of infant feeding practices in Vietnamese-born mothers living in Australia. BMC Pregnancy Childbirth 2022; 22:895. [PMID: 36463117 PMCID: PMC9719657 DOI: 10.1186/s12884-022-05223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Infant feeding practices are a key modifiable risk factor for childhood overweight and obesity; and important for lifelong health and wellbeing. Despite the growing Australian immigrant population, it is unclear how infant feeding practices may differ between ethnicities living in Australia. Few studies have examined the infant feeding practices of Vietnamese mothers who migrate and give birth to infants in Australia - termed Vietnamese-born mothers. The aim of this study was to examine differences in infant feeding practices (breastfeeding, formula feeding and complementary feeding (other fluids and solids)) in Vietnamese-born mothers compared with Australian-born mothers living in Australia. METHOD This study analysed the Australian National Infant Feeding Survey dataset (2010-11), a large national cross-sectional survey measuring feeding practices of infants aged 0-24 months old. Infant feeding practices of Vietnamese-born mothers (n = 261) and a random sub-sample of Australian-born mothers (n = 261) were compared. Associations between ethnicity and infant feeding practices were examined through logistic and linear regression adjusting for maternal age, socioeconomic status, body mass index (BMI) at start of pregnancy, infant age at survey completion and parity. Compliance with the Australian national infant feeding guidelines was also assessed. RESULTS Compliance with infant feeding guidelines was low, with differences in infant feeding practices between groups. At the time of survey completion, when infants were on average 7.2 months old, compared with infants of Australian-born mothers, infants to Vietnamese-born mothers were significantly younger when first exposed to fruit juice (b = -2.41, 95%CI: -4.54- -0.28); less likely to be exposed to solids (AOR: 0.15, 95%CI: 0.05-0.44) and more likely to be exposed to formula milks (AOR: 2.21, 95%CI: 1.10-4.43); toddler milks (AOR: 16.72, 95%CI: 3.11-90.09) and fruit juice (AOR: 2.37, 95%CI: 1.06-5.32) (p < 0.05). CONCLUSION Low adherence with breastfeeding (low breastfeeding and high infant formula use) and other fluids (toddler milks and fruit juice) recommendations outlined by the Australian infant feeding guidelines were observed in this group of Vietnamese-born mothers. To optimise feeding and growth in Vietnamese-Australian children, culturally appropriate infant feeding support targeting breastfeeding durations, reducing reliance on infant formula, and reducing inappropriate introduction to other fluids should be the focus of infant feeding promotion within these mothers.
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Affiliation(s)
- Lauren Zahra
- grid.1021.20000 0001 0526 7079School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC Australia
| | - Peter Kremer
- grid.1021.20000 0001 0526 7079Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Kristy A. Bolton
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
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Sokou R, Parastatidou S, Ioakeimidis G, Tavoulari EF, Makrogianni A, Isaakidou E, Iacovidou N, Konstantinidi A. Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up. Nutrients 2022; 14:nu14183841. [PMID: 36145216 PMCID: PMC9500865 DOI: 10.3390/nu14183841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Athanasia Makrogianni
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Elina Isaakidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
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Chung EK, Painter I, Sitcov K, Souter VD. Exclusive Breastfeeding in the Northwest: Disparities Related to Race/Ethnicity and Substance Use. Acad Pediatr 2022; 22:918-926. [PMID: 34600112 DOI: 10.1016/j.acap.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Mothers who are Black, Indigenous, and people of color (BIPOC) are disproportionately impacted by substance use in pregnancy and less likely to breastfeed. Our objectives were to assess relationships between substance use in pregnancy and exclusive breastfeeding at discharge (EBF) and race/ethnicity and EBF, and determine the extent to which substance use influences the relationship between race/ethnicity and EBF. METHODS This is a retrospective cohort study of term mother-infant dyads using 2016 to 2019 data from a Northwest quality improvement collaborative, Obstetrical Care Outcomes Assessment Program. Stepwise and stratified multivariable logistic regression analyses were conducted to determine associations between independent variables consisting of characteristics, including maternal race/ethnicity and substance use, and the dependent variable, EBF. RESULTS Our sample consisted of 84,742 dyads, 69.5% of whom had EBF. The adjusted odds of EBF for non-Hispanic Black and Hispanic mothers were half, and for American Indian/Alaska Native mothers two-thirds, that of White mothers (aOR [95% CI]: 0.52 [0.48, 0.57], 0.51 [0.48, 0.54], 0.64 [0.55, 0.76], respectively). Substance use did not mediate the association between race/ethnicity and EBF, but it modified the association. Among those reporting nicotine or marijuana use, Hispanic mothers were half as likely as White mothers were to exclusively breastfeed. Other factors associated with a lower likelihood of EBF included public or no insurance, rural setting, C-section, NICU admission, and LBW. CONCLUSIONS Disparities in EBF related to race/ethnicity and substance use were pronounced in this study, particularly among Hispanic mothers with nicotine or marijuana use.
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Affiliation(s)
- Esther K Chung
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital (EK Chung).
| | - Ian Painter
- Department of Health Services, University of Washington (I Painter and VD Souter), Seattle, Wash; The Foundation for Health Care Quality (I Painter, K Sitcov, and VD Souter), Seattle, Wash
| | - Kristin Sitcov
- The Foundation for Health Care Quality (I Painter, K Sitcov, and VD Souter), Seattle, Wash
| | - Vivienne D Souter
- Department of Health Services, University of Washington (I Painter and VD Souter), Seattle, Wash; The Foundation for Health Care Quality (I Painter, K Sitcov, and VD Souter), Seattle, Wash
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Roess AA, Robert RC, Kuehn D, Ume N, Ericson B, Woody E, Vinjamuri S, Thompson P. Disparities in Breastfeeding Initiation Among African American and Black Immigrant WIC Recipients in the District of Columbia, 2007-2019. Am J Public Health 2022; 112:671-674. [PMID: 35319957 PMCID: PMC8961857 DOI: 10.2105/ajph.2021.306652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate differences in breastfeeding initiation (BFI) rates between African Americans and Black immigrants enrolled in the District of Columbia Special Supplemental Nutrition Program for Women, Infants and Children (WIC) between 2007 and 2019. Methods. We used data collected as part of routine WIC program activities for first-time mothers (n = 38 142). Using multivariable logistic regression models, we identified determinants of BFI for African Americans, Black immigrants, non-Hispanic Whites, and Hispanics. To assess the trend in BFI over time, we calculated the average of the annual percentage changes. Results. Compared with African Americans, Black immigrants had a 2.7-fold higher prevalence and Hispanics had a 5.8-fold higher prevalence of BFI. The average of the annual percentage changes was 0.85 for Hispanics, 3.44 for Black immigrants, 4.40 for Non-Hispanic Whites, and 4.40 for African Americans. African Americans had the only statistically significant change (P < .05). Disparities in BFI persisted over the study period, with African Americans demonstrating the lowest rates each year. Conclusions. Significant differences exist in BFI between Black immigrants and African Americans. Combining African Americans and Black immigrants masks important differences, overestimates rates among African Americans, and may lead to missed opportunities for targeting interventions and policies to improve breastfeeding. (Am J Public Health. 2022;112(4):671-674. https://doi.org/10.2105/AJPH.2021.306652).
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Affiliation(s)
- Amira A Roess
- Amira A. Roess is with the College of Health and Human Services, George Mason University, Fairfax, VA. Rebecca C. Robert is with the Conway School of Nursing, Catholic University of America, Washington, DC. Doris Kuehn, Emily Woody, Swathi Vinjamuri, and Paulette Thompson are with the District of Columbia Department of Health, District of Columbia Women Infant Child State Agency, Washington, DC. Nwanneamaka Ume is with the Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Brianna Ericson is with the Department of Epidemiology, Milken Institute School of Public Health
| | - Rebecca C Robert
- Amira A. Roess is with the College of Health and Human Services, George Mason University, Fairfax, VA. Rebecca C. Robert is with the Conway School of Nursing, Catholic University of America, Washington, DC. Doris Kuehn, Emily Woody, Swathi Vinjamuri, and Paulette Thompson are with the District of Columbia Department of Health, District of Columbia Women Infant Child State Agency, Washington, DC. Nwanneamaka Ume is with the Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Brianna Ericson is with the Department of Epidemiology, Milken Institute School of Public Health
| | - Doris Kuehn
- Amira A. Roess is with the College of Health and Human Services, George Mason University, Fairfax, VA. Rebecca C. Robert is with the Conway School of Nursing, Catholic University of America, Washington, DC. Doris Kuehn, Emily Woody, Swathi Vinjamuri, and Paulette Thompson are with the District of Columbia Department of Health, District of Columbia Women Infant Child State Agency, Washington, DC. Nwanneamaka Ume is with the Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Brianna Ericson is with the Department of Epidemiology, Milken Institute School of Public Health
| | - Nwanneamaka Ume
- Amira A. Roess is with the College of Health and Human Services, George Mason University, Fairfax, VA. Rebecca C. Robert is with the Conway School of Nursing, Catholic University of America, Washington, DC. Doris Kuehn, Emily Woody, Swathi Vinjamuri, and Paulette Thompson are with the District of Columbia Department of Health, District of Columbia Women Infant Child State Agency, Washington, DC. Nwanneamaka Ume is with the Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Brianna Ericson is with the Department of Epidemiology, Milken Institute School of Public Health
| | - Brianna Ericson
- Amira A. Roess is with the College of Health and Human Services, George Mason University, Fairfax, VA. Rebecca C. Robert is with the Conway School of Nursing, Catholic University of America, Washington, DC. Doris Kuehn, Emily Woody, Swathi Vinjamuri, and Paulette Thompson are with the District of Columbia Department of Health, District of Columbia Women Infant Child State Agency, Washington, DC. Nwanneamaka Ume is with the Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Brianna Ericson is with the Department of Epidemiology, Milken Institute School of Public Health
| | - Emily Woody
- Amira A. Roess is with the College of Health and Human Services, George Mason University, Fairfax, VA. Rebecca C. Robert is with the Conway School of Nursing, Catholic University of America, Washington, DC. Doris Kuehn, Emily Woody, Swathi Vinjamuri, and Paulette Thompson are with the District of Columbia Department of Health, District of Columbia Women Infant Child State Agency, Washington, DC. Nwanneamaka Ume is with the Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Brianna Ericson is with the Department of Epidemiology, Milken Institute School of Public Health
| | - Swathi Vinjamuri
- Amira A. Roess is with the College of Health and Human Services, George Mason University, Fairfax, VA. Rebecca C. Robert is with the Conway School of Nursing, Catholic University of America, Washington, DC. Doris Kuehn, Emily Woody, Swathi Vinjamuri, and Paulette Thompson are with the District of Columbia Department of Health, District of Columbia Women Infant Child State Agency, Washington, DC. Nwanneamaka Ume is with the Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Brianna Ericson is with the Department of Epidemiology, Milken Institute School of Public Health
| | - Paulette Thompson
- Amira A. Roess is with the College of Health and Human Services, George Mason University, Fairfax, VA. Rebecca C. Robert is with the Conway School of Nursing, Catholic University of America, Washington, DC. Doris Kuehn, Emily Woody, Swathi Vinjamuri, and Paulette Thompson are with the District of Columbia Department of Health, District of Columbia Women Infant Child State Agency, Washington, DC. Nwanneamaka Ume is with the Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC. Brianna Ericson is with the Department of Epidemiology, Milken Institute School of Public Health
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Ayers BL, Purvis RS, White A, CarlLee S, Andersen JA, Bogulski CA, McElfish PA. Best of Intentions: Influential Factors in Infant Feeding Intent among Marshallese Pregnant Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031740. [PMID: 35162763 PMCID: PMC8834797 DOI: 10.3390/ijerph19031740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 01/26/2023]
Abstract
The purpose of this study is to explore the beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding intent among Marshallese pregnant women in the United States (US). The study used a descriptive qualitative design. In total, 36 Marshallese women in their third trimester of pregnancy participated. Participants described exclusive breastfeeding as the preferred method of infant feeding, from both individual and community perspectives. Exclusive breastfeeding was viewed as the healthiest for the infant, viewed as offering protection against sickness, and viewed as better for the overall development of the infant. Of the 36 participants, 28 participants (77.8%) stated that their infant feeding intentions included a hybrid of breastfeeding and formula feeding. The dominant barrier to exclusive breastfeeding was the need to work outside of the home. Unexpected barriers to exclusive breastfeeding were the desire for autonomy and a preference to exclusively breastfeed female infants more than male infants. Exclusive breastfeeding facilitators included support from the Special Supplemental Nutrition Program for Women, Infants, and Children and support and encouragement from female family/community members. This study is the first to document beliefs, intentions, and influences that serve as barriers and facilitators to exclusive breastfeeding among Marshallese pregnant women residing in the US.
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Affiliation(s)
- Britni L. Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
- Correspondence: ; Tel.: +1-(479)-713-8662
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
| | - Alexis White
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA;
| | - Sheena CarlLee
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
| | - Cari A. Bogulski
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA;
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA; (R.S.P.); (S.C.); (J.A.A.); (P.A.M.)
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Strategies to Improve Mother's Own Milk Expression in Black and Hispanic Mothers of Premature Infants. Adv Neonatal Care 2022; 22:59-68. [PMID: 33756497 DOI: 10.1097/anc.0000000000000866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mother's own milk (MOM) is the gold standard of nutrition for premature infants. Yet, Hispanic and Black preterm infants are less likely than their White counterparts to receive MOM feedings. Evidence is lacking concerning potential modifiable factors and evidence-based strategies that predict provision of MOM among minority mothers of premature infants. PURPOSE A review of the literature was conducted to answer the clinical question: "What evidence-based strategies encourage and improve mother's own milk expression in Black and Hispanic mothers of premature infants?" METHODS/SEARCH STRATEGY Multiple databases including PubMed, Cochrane, and CINAHL were searched for articles published in the past 10 years (2010 through May 2020), reporting original research and available in English. Initial search yielded zero articles specifically addressing the impact of lactation interventions on MOM provision in minority mothers. Additional studies were included and reviewed if addressed breastfeeding facilitators and barriers (n = 3) and neonatal intensive care unit breastfeeding support practices (n = 7). FINDINGS/RESULTS Current strategies used to encourage and improve MOM expression in minority mothers are based on or extrapolated from successful strategies developed and tested in predominantly White mothers. However, limited evidence suggests that variation in neonatal intensive care unit breastfeeding support practices may explain (in part) variation in disparities and supports further research in this area. IMPLICATIONS FOR PRACTICE Neonatal intensive care unit staff should consider implementing scaled up or bundled strategies showing promise in improving MOM milk expression among minorities while taking into consideration the cultural and racial norms influencing breastfeeding decisions and practice. IMPLICATIONS FOR RESEARCH Experimental studies are needed to evaluate the effectiveness of targeted and culturally sensitive lactation support interventions in Hispanic and Black mothers.
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14
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Witt R, Vatti T, Lasko L, Witt AM. Team-Based Breastfeeding Support at a Federally Qualified Health Center: Efficacy, Utilization, and Patient Satisfaction. Breastfeed Med 2021; 16:741-749. [PMID: 33956505 DOI: 10.1089/bfm.2021.0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: A team-based, integrated lactation consultant (LC) and primary care provider (PCP) program improves breastfeeding rates in some outpatient settings, but only a limited number of studies have assessed efficacy in socioeconomically and racially diverse communities. Objectives: Following implementation of team-based LC/PCP care at a Federally Qualified Health Center (FQHC), quality improvement efforts assessed utilization, breastfeeding rates, and patient satisfaction. Method: A retrospective chart review examined feeding status pre- and postimplementation. Analysis compared feeding rates at the 2-week, 2-month, 4-month, and 6-month well visits (well child care). Subanalysis of patients who initiated breastfeeding postimplementation examined feeding status and LC support. Patient survey evaluated satisfaction. Results: Among patients who initiated breastfeeding, those who received a LC/PCP visit were significantly more likely to be breastfeeding at 2 weeks (94% versus 80%, p = 0.004) and 4 months (68% versus 45%, p = 0.01). However, breastfeeding rates for the whole practice were not significantly different before and after implementation. Seventy-two percent of breastfeeding families saw a LC (n = 204). Median LC visit per breastfeeding patient was 1.18 (standard deviation [SD] +1.2). Patient survey reported that the three most commonly helpful aspects of the visit were "latch instruction" (60%), "breastfeeding questions answered" (80%) and "learning about massage and hand expression" (50%). Discussion: Team-based LC/PCP care is feasible at a FQHC. Patients found it helpful. Among families who initiated breastfeeding, receiving LC/PCP care was associated with increased breastfeeding duration through 4 months.
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Affiliation(s)
- Rachel Witt
- Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio, USA
| | - Thanvi Vatti
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lauren Lasko
- Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio, USA.,Neighborhood Family Practice, Cleveland, Ohio, USA
| | - Ann M Witt
- Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Sanefuji M, Senju A, Shimono M, Ogawa M, Sonoda Y, Torio M, Ichimiya Y, Suga R, Sakai Y, Honjo S, Kusuhara K, Ohga S. Breast feeding and infant development in a cohort with sibling pair analysis: the Japan Environment and Children's Study. BMJ Open 2021; 11:e043202. [PMID: 34380712 PMCID: PMC8359520 DOI: 10.1136/bmjopen-2020-043202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To investigate the association between breast feeding and infant development during the first year of life using sibling comparison. DESIGN Nationwide prospective birth cohort study with sibling pair analysis. SETTING 15 regional centres that participated in the Japan Environment and Children's Study. PARTICIPANTS This study included 77 119 children (singleton, term birth and no malformation/severe diseases) whose mothers were registered between January 2011 and March 2014, including 3521 duos or trios of siblings. PRIMARY OUTCOME MEASURES The primary outcome was developmental delay at 6 and 12 months of age, assessed using the Japanese translation of the Ages and Stages Questionnaires, third edition. Multivariable regression analyses adjusted for confounders were performed to estimate the risk ratios of delay associated with any or exclusive breast feeding. Pairs of siblings discordant for statuses were selected, and conditional regression analyses were conducted with a matched cohort design. RESULTS Developmental delay was identified in 6162 (8.4%) and 10 442 (14.6%) children at 6 and 12 months of age, respectively. Any breast feeding continued until 6 months or 12 months old was associated with reduced developmental delay at 12 months of age (adjusted risk ratio (95% CI): 0.81 (0.77 to 0.85) and 0.81 (0.78 to 0.84), respectively). Furthermore, exclusive breast feeding until 3 months was associated with reduced developmental delay at 12 months of age (adjusted risk ratio, 0.86 (95% CI 0.83 to 0.90)). In sibling pair analysis, the association between any breast feeding until 12 months and reduced developmental delay at 12 months of age persisted (adjusted risk ratio, 0.64 (95% CI 0.43 to 0.93)). CONCLUSIONS The present study demonstrated the association of continuous breast feeding with reduced developmental delay at 1 year of age using sibling pair analysis, in which unmeasured confounding factors are still present but less included. This may provide an argument to promote breastfeeding continuation.
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Affiliation(s)
- Masafumi Sanefuji
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayako Senju
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masayuki Shimono
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masanobu Ogawa
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuri Sonoda
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michiko Torio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Reiko Suga
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shouichi Ohga
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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' [The pediatrician] said that maybe my milk, instead of doing good, no longer helped': the ecology of infant formula in rural communities in Central Mexico. Public Health Nutr 2021; 24:3879-3891. [PMID: 34187610 DOI: 10.1017/s1368980021002433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE As Mexico continues to develop, an epidemiological and nutritional transition has led to an increase in infant formula use in its rural and indigenous communities. Our objective was to determine the social and cultural factors that influence the use of formula in such populations in Central Mexico. DESIGN Qualitative study using a data collection instrument based on the socio-ecological framework. SETTING Two rural and indigenous communities in Central Mexico. PARTICIPANTS Mothers, fathers, grandparents and healthcare providers. RESULTS Breast-feeding was favoured in both communities; however, several cultural traditions hindered exclusive breast-feeding. As these communities became more developed, emerging ideas of modernity led to negative connotations about breast-feeding and many mothers began to view formula as a complement for breast-feeding. Formula was seen as a convenient solution for breast pain, insufficient milk and body image. Healthcare providers promoted the use of formula through their own beliefs, information, communication and conflicts of interest with formula industry representatives. The recent social and economic changes in these communities combined with the increased advertising and availability of breast milk substitutes have facilitated the preference for formula. CONCLUSIONS Women in rural, indigenous communities in Central Mexico are increasingly using formula. Efforts at the policy and institutional levels are needed to protect mothers and their children from the detrimental consequences of unregulated formula promotion and the formula culture that it brings with it.
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Abstract
Introduction: Breast milk is the ideal food for infants. However, at 6 months of age, <25% of infants in the United States are exclusively breastfed. While racial disparities in breastfeeding have been documented, questions remain about the contributions of paternal race and ethnicity to breastfeeding. Materials and Methods: This single-site, prospective study investigated the association of parental characteristics and exclusive breastfeeding (EBF). EBF and non-EBF (N-EBF) infants who were >35 weeks gestational age were compared at nursery discharge and ∼30 days of age. Results: At nursery discharge (n = 499), mean birth weight (±standard deviation [SD]) was greater in the EBF versus N-EBF cohort (3.4 ± 0.4 versus 3.3 ± 0.5 kg, p = 0.01). When compared to the N-EBF cohort, infants in the EBF cohort were significantly more likely to have the following characteristics: (1) vaginal birth; (2) non-Hispanic parents; (3) parents with higher socioeconomic status, and (4) parents who are English-speaking (p < 0.01 for all). Similar findings persisted at 30 days. Non-Hispanic parents were 2 (95% confidence interval [CI]: 1.4-3.3) and 3.5 (95% CI: 1.5-7.9) times more likely to exclusively breastfeed than Hispanic parents at nursery discharge and 30 days, respectively. At nursery discharge, families with a Hispanic mother and non-Hispanic father were more likely to EBF than families with a Hispanic mother and father (odds ratio 2.9, 95% CI: 1.1-7.6). In multivariate model, parental ethnicity was associated with EBF at discharge (p = 0.03) and 30 days (p = 0.02). Conclusion: Paternal ethnicity may influence EBF. Addressing disparities in EBF may warrant investigations into culturally inclusive and family-centered interventions.
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Affiliation(s)
- Neema Pithia
- UCLA Mattel Children's Hospital, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, USA
| | - Ashley Dong
- Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Tristan Grogan
- Department of Medicine, Statistics Core, University of California, Los Angeles, Los Angeles, California, USA
| | - Sparsha Govardhan
- Division of Neonatology & Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Kara L. Calkins
- Division of Neonatology & Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, University of California, Los Angeles, Los Angeles, California, USA
- Address correspondence to: Kara L. Calkins, MD, MS, Division of Neonatology and Developmental Biology, Department of Pediatrics, Neonatal Research Center of the UCLA Children's Discovery and Innovation Institute, University of California, Los Angeles, 10833 Le Conte Avenue, Room B2375 MDCC, Los Angeles, CA 90095, USA
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18
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Casey JA, Mango M, Mullendore S, Kiang MV, Hernández D, Li BH, Li K, Im TM, Tartof SY. Trends from 2008 to 2018 in Electricity-dependent Durable Medical Equipment Rentals and Sociodemographic Disparities. Epidemiology 2021; 32:327-335. [PMID: 33591051 PMCID: PMC8140591 DOI: 10.1097/ede.0000000000001333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Duration and number of power outages have increased over time, partly fueled by climate change, putting users of electricity-dependent durable medical equipment (hereafter, "durable medical equipment") at particular risk of adverse health outcomes. Given health disparities in the United States, we assessed trends in durable medical equipment rental prevalence and individual- and area-level sociodemographic inequalities. METHODS Using Kaiser Permanente South California electronic health record data, we identified durable medical equipment renters. We calculated annual prevalence of equipment rental and fit hierarchical generalized linear models with ZIP code random intercepts, stratified by rental of breast pumps or other equipment. RESULTS 243,559 KPSC members rented durable medical equipment between 2008 and 2018. Rental prevalence increased over time across age, sex, racial-ethnic, and Medicaid categories, most by >100%. In adjusted analyses, Medicaid use was associated with increased prevalence and 108 (95% confidence interval [CI] = 99, 117) additional days of equipment rental during the study period. ZIP code-level sociodemographics were associated with increased prevalence of equipment rentals, for example, a 1 SD increase in percent unemployed and CONCLUSIONS We observed some socioeconomic disparities among a growing electricity-dependent population. Our findings are consistent with the hypothesis that reliable electricity access is increasingly required to meet the health needs of medically disadvantaged groups. See video abstract at http://links.lww.com/EDE/B793.
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Affiliation(s)
- Joan A. Casey
- Columbia University Mailman School of Public Health, New York, NY
| | | | | | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Diana Hernández
- Columbia University Mailman School of Public Health, New York, NY
| | - Bonnie H. Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Kris Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Theresa M. Im
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Sara Y. Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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Su Q, Sun X, Zhu L, Yan Q, Zheng P, Mao Y, Ye D. Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis. BMC Med 2021; 19:90. [PMID: 33845843 PMCID: PMC8042913 DOI: 10.1186/s12916-021-01950-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to quantitatively summarize the available evidence on the association of breastfeeding with the risk of childhood cancer. METHODS A literature search of PubMed and Embase databases was performed to identify eligible observational studies published from inception to July 17, 2020. The categorical and dose-response meta-analysis was conducted by pooling relative risk (RR) or odds ratio (OR) estimates with 95% confidence intervals (CIs). Potential sources of heterogeneity were detected by meta-regression and stratification analysis. Sensitivity analysis and publication bias test were also carried out. RESULTS Forty-five articles involving 475,579 individuals were included in the meta-analysis. Among the thirty-three studies on the association between breastfeeding and risk of childhood leukemia, the pooled risk estimates were 0.77 (95% CI, 0.65-0.91) and 0.77 (95% CI 0.63-0.94) for ever versus non/occasional breastfeeding and longest versus shortest breastfeeding duration group, respectively. There was clear indication for non-linear dose-response relationship between breastfeeding duration and the risk of childhood leukemia (P non-linear < 0.001). The most protective effect (OR, 0.66, 95% CI 0.62-0.70) was observed at a breastfeeding duration of 9.6 months. Four studies examined, the association between breastfeeding and risk of childhood neuroblastoma, and significant inverse associations were consistently observed in both the comparisons of ever breastfeeding versus non/occasional breastfeeding (OR = 0.59, 95% CI 0.44-0.81) and longest versus shortest breastfeeding (OR = 0.61, 95% CI 0.44-0.83). However, no associations of breastfeeding with risk of other cancers were found. CONCLUSIONS Our study supports a protective role of breastfeeding on the risk of childhood leukemia, also suggesting a non-linear dose-response relationship. Further studies are warranted to confirm the association between breastfeeding and risk of childhood neuroblastoma.
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Affiliation(s)
- Qing Su
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China
| | - Xiaohui Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China
| | - Liwen Zhu
- Department of Hematology and Oncology, Children's hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Qin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China
| | - Peiwen Zheng
- Department of Medical Adiministration, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Yingying Mao
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China.
| | - Ding Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, China.
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20
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Frenoy P, Vandentorren S, Arnaud A, Vuillermoz C, Rico Berrocal R, Martin-Fernandez J, Azria E, de Lauzon-Guillain B, Bernard JY, Lioret S. Demographic, socioeconomic, and sociocultural factors associated with any breastfeeding in homeless mothers. MATERNAL AND CHILD NUTRITION 2021; 17:e13167. [PMID: 33780138 PMCID: PMC8189215 DOI: 10.1111/mcn.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
In high-income countries, breastfeeding has been shown to be positively associated with socioeconomic position. However, less is known about breastfeeding practices and their associated factors among extremely disadvantaged populations. We aimed to assess the associations of cultural origins and socioeconomic factors with any breastfeeding initiation and duration in homeless families. We analyzed data from 456 children aged 6 months to 5 years from the cross-sectional ENFAMS survey, conducted in 2013 among a random sample of homeless families in shelters in the Greater Paris area. Data were collected by bilingual interviewers in 17 languages. Four nested multivariable robust Poisson regression models were run in a hierarchical framework to determine the factors associated with breastfeeding initiation and with any breastfeeding for 6 months or more. Most of the children (86.0%) had previously been or were currently being breastfed at the time of the survey; 58.9% were fed with breast milk ≥6 months. A higher maternal age and African origin were positively associated with breastfeeding ≥6 months, although the relation to the region of origin was moderated by education level. Migration to escape war, unrest or other violence and the child's birth in France were inversely associated with breastfeeding ≥6 months. Any breastfeeding by these homeless mothers seems influenced predominantly by their cultural origin and complicated by a difficult migration trajectory. The possible influence of poor material circumstances and cumulative hardship should encourage interventions targeted at homeless mothers that emphasize social/family support with a commitment to improving the family's living conditions.
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Affiliation(s)
- Pauline Frenoy
- Université de Paris, CRESS, INSERM, INRAE, Paris, France
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, Saint-Maurice, France.,Institut Pierre Louis d'Épidémiologie et de Santé Publique, Department of Social Epidemiology, INSERM, Sorbonne Université, Paris, France
| | | | - Cécile Vuillermoz
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Department of Social Epidemiology, INSERM, Sorbonne Université, Paris, France
| | | | - Judith Martin-Fernandez
- INSERM, Bordeaux Population Health Research Center, UMR 1219, CIC1401-EC, University of Bordeaux, ISPED, Bordeaux, France
| | - Elie Azria
- Université de Paris, CRESS, INSERM, INRAE, Paris, France.,Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Jonathan Y Bernard
- Université de Paris, CRESS, INSERM, INRAE, Paris, France.,Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore
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21
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Safon CB, Heeren TC, Kerr SM, Clermont D, Corwin MJ, Colson ER, Moon RY, Kellams AL, Hauck FR, Parker MG. Disparities in Breastfeeding Among U.S. Black Mothers: Identification of Mechanisms. Breastfeed Med 2021; 16:140-149. [PMID: 33539248 PMCID: PMC7891211 DOI: 10.1089/bfm.2020.0310] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: Disparities in U.S. breastfeeding rates persist among Black mothers according to birth country and between Black and White mothers, necessitating further investigation of modifiable mediating factors to inform interventions. This study seeks to examine the extent that social, maternal, infant factors and Theory of Planned Behavior (TPB) domains (attitudes, perceived control, and subjective norms) mediate the association of maternal race/birth country and breastfeeding continuation. Methods: A national cohort of 2,050 mothers self-identifying as U.S.-born non-Hispanic Black (n = 689), foreign-born non-Hispanic Black (n = 139), and U.S.-born non-Hispanic White (n = 1,222) was analyzed. Using logistic regression, associations of race/birth country and any/exclusive breastfeeding at 2-6 months were examined. Structural equation modeling was used to determine whether social, maternal, and infant factors and TPB domains mediate these relationships. Results: 40.0% of U.S.-born Black, 82.2% of foreign-born Black, and 57.3% of U.S.-born White mothers reported any breastfeeding at 2-6 months. Compared with U.S.-born Black mothers, odds of any breastfeeding were sevenfold higher among foreign-born Black mothers (odds ratio [OR] = 7.04 95% confidence interval [CI] = 4.80-10.31), which was explained partly by social/maternal/infant factors and TPB domains. Compared with U.S.-born White mothers, any breastfeeding was lower (OR = 0.54, 95% CI = 0.40-0.73) among U.S.-born Black mothers and higher (OR = 3.81, 95% CI = 2.48-5.87) among foreign-born Black mothers; these differences were also mediated by the aforementioned factors. Conclusions: Among Black mothers in the United States, breastfeeding continuation varied substantially by birth country. Promotion of interventions targeting positive attitudes, perceived control, and subjective norms may reduce disparities among Black and between Black and White mothers.
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Affiliation(s)
- Cara B Safon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts, USA
| | - Daphney Clermont
- Slone Epidemiology Center, Boston University, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Cardinal Glennon Children's Hospital, St. Louis University, St. Louis City County, Missouri, USA
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University, Boston, Massachusetts, USA.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eve R Colson
- Department of Pediatrics, Washington University, St. Louis, Missouri, USA
| | - Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Ann L Kellams
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Margaret G Parker
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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22
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Patel AL, Johnson TJ, Meier PP. Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units. Pediatr Res 2021; 89:344-352. [PMID: 33188286 PMCID: PMC7662724 DOI: 10.1038/s41390-020-01263-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
Very low birth weight (VLBW; <1500 g birth weight) infants are substantially more likely to be born to black than to non-black mothers, predisposing them to potentially preventable morbidities that increase the risk for costly lifelong health problems. Mothers' own milk (MOM) may be considered the ultimate "personalized medicine" since milk composition and bioactive components vary among mothers and multiple milk constituents provide specific protection based on shared exposures between mother and infant. MOM feedings reduce the risks and associated costs of prematurity-associated morbidities, with the greatest reduction afforded by MOM through to NICU discharge. Although black and non-black mothers have similar lactation goals and initiation rates, black VLBW infants are half as likely to receive MOM at NICU discharge in the United States. Black mothers are significantly more likely to be low-income, single heads of household and have more children in the home, increasing the burden of MOM provision. Although rarely considered, the out-of-pocket and opportunity costs associated with providing MOM for VLBW infants are especially onerous for black mothers. When MOM is not available, the NICU assumes the costs of inferior substitutes for MOM, contributing further to disparate outcomes. Novel strategies to mitigate these disparities are urgently needed. IMPACT: Mother's own milk exemplifies personalized medicine through its unique biologic activity. Hospital factors and social determinants of health are associated with mother's own milk feedings for very low-birth-weight infants in the neonatal intensive care unit. Notably, out-of-pocket and opportunity costs associated with providing mother's own milk are borne by mothers. Conceptualizing mother's own milk feedings as an integral part of NICU care requires consideration of who bears the costs of MOM provision-the mother or the NICU?
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Affiliation(s)
- Aloka L. Patel
- grid.262743.60000000107058297Department of Pediatrics, Rush University Children’s Hospital, Chicago, IL USA
| | - Tricia J. Johnson
- grid.262743.60000000107058297Departments of Health Systems Management, Rush University, Chicago, IL USA
| | - Paula P. Meier
- grid.262743.60000000107058297Department of Pediatrics, Rush University Children’s Hospital, Chicago, IL USA ,grid.240684.c0000 0001 0705 3621College of Nursing, Rush University Medical Center, Chicago, IL USA
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23
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Hoyt-Austin A, Dove MS, Abrahão R, Kair LR, Schwarz EB. Awareness That Breastfeeding Reduces Breast Cancer Risk: 2015-2017 National Survey of Family Growth. Obstet Gynecol 2020; 136:1154-1156. [PMID: 33156184 PMCID: PMC7724754 DOI: 10.1097/aog.0000000000004162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Only 38.5% of U.S. women are aware that breastfeeding is associated with reduced incidence of breast cancer, and efforts are needed to educate pregnant women of the maternal health benefits breastfeeding provides.
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Affiliation(s)
- Adrienne Hoyt-Austin
- Departments of Pediatrics, Public Health Sciences, and Medicine and the Center for Healthcare Policy & Research, University of California, Davis, Sacramento, California
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24
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Motherhood in Europe: An Examination of Parental Leave Regulations and Breastfeeding Policy Influences on Breastfeeding Initiation and Duration. SOCIAL SCIENCES 2020. [DOI: 10.3390/socsci9120222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examines how European variation in breastfeeding initiation and duration rates is related to the presence of baby-friendly hospitals, the international code of marketing of breast-milk substitutes, and different constellations of maternal, paternal, and parental leave. We use Eurobarometer data (2005) to compare initiation and duration levels across 21 European countries within a multilevel regression framework. We find that countries play a significant role in determining breastfeeding through their different social policies. Breastfeeding practices across different leave regulation models differ substantially. We conclude that ongoing changes in paid maternity and parental leave length combined with uptake flexibility and paternal involvement help determine breastfeeding rates and should put infant feeding issues on governmental policy agendas across European countries.
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25
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Kummer L, Duke N, Davis L, Borowsky I. Association of Social and Community Factors with U.S. Breastfeeding Outcomes. Breastfeed Med 2020; 15:646-654. [PMID: 32856942 DOI: 10.1089/bfm.2020.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To explore, in a large, nationally representative U.S. sample of children, potential independent associations between social and community factors and breastfeeding outcomes, using the Social Ecological Model as a theoretical framework. Materials and Methods: A secondary data analysis of the 2011-2012 National Survey of Children's Health was conducted (N = 29,829). Multivariate logistic regression was performed to estimate associations between predictor variables (parental emotional support, neighborhood social support, neighborhood safety, neighborhood amenities, and medical home) and breastfeeding outcomes (breastfeeding initiation [BFI] and exclusive breastfeeding for 6 months [EBF6m]). For predictor variables reaching statistical significance in the adjusted models, we performed subgroup analyses by race-ethnicity. Results: After adjusting for individual- and family-level sociodemographic and maternal-child health factors, living in a neighborhood with 4 amenities was associated with 1.54 (95% confidence interval [CI] 1.06-2.23) times the odds of BFI, compared to children living in neighborhoods with no amenities. There was a negative association (adjusted odds ratio [aOR] 0.83; 95% CI 0.70-0.99) between neighborhood social support and BFI, although living in a supportive neighborhood was associated with 1.37 (95% CI 1.11-1.69) times the odds of EBF6m. There was a negative association (aOR 0.71; 95% CI 0.54-0.93) between perceived neighborhood safety and EBF6m. The observed associations differed by race-ethnicity. Conclusion: Community-level structural and social support factors influence breastfeeding outcomes, independent of previously described individual level sociodemographic factors, and the observed associations differ by race-ethnicity. These findings have implications for the development of "breastfeeding-friendly" communities and public policies.
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26
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Trabulsi JC, Smethers AD, Eosso JR, Papas MA, Stallings VA, Mennella JA. Impact of early rapid weight gain on odds for overweight at one year differs between breastfed and formula-fed infants. Pediatr Obes 2020; 15:e12688. [PMID: 32705816 PMCID: PMC7773222 DOI: 10.1111/ijpo.12688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early rapid weight gain (RWG) increases, whereas longer durations of breastfeeding decreases, odds for later obesity. OBJECTIVES To determine the independent and interactive effects of early weight gain and diet on infant weight status trajectories and odds for overweight at 1 year. METHODS We conducted secondary analysis on data from two longitudinal trials with repeated anthropometric measures. One trial consisted of predominantly or exclusively breastfed (BF, n = 97) infants, whereas the other consisted of exclusively formula-fed (FF, n = 113) infants. Weight-for-length z-score (WLZ) change from 0.5 to 4.5 months was used to categorize early weight gain as slow (<-0.67; SWG), normal (-0.67 to 0.67; NWG) or rapid (>0.67; RWG). Linear-mixed effects models were fit to examine the independent effects and interaction of early diet (BF, FF) and weight gain (SWG, NWG, RWG) groups on WLZ trajectories; logistic regression was used to assess odds for overweight at 1 year. RESULTS While similar percentages (41%) of BF and FF infants experienced RWG, we found a significant diet × early weight gain group interaction (P < .001) on weight status. At 1 year, the WLZ of FF infants with RWG (1.57 ± 0.99) was twice that of BF infants with RWG (0.83 ± 0.92). Using BF infants with NWG as the reference group, FF infants with RWG had increased odds [OR: 25.3 (95% CI: 3.21, 199.7)] for overweight at 1 year, whereas BF infants with RWG did not. CONCLUSIONS Early diet interacts with early weight gain and influences weight status trajectories and overweight risk at 1 year.
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Affiliation(s)
- Jillian C. Trabulsi
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware
| | | | - Jessica R. Eosso
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware
| | - Mia A. Papas
- The Value Institute, Christiana Care Health System, Newark, Delaware
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27
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Abstract
OBJECTIVE To estimate whether maternal sense of control in labor is associated with breastfeeding at 4-8 weeks postpartum. METHODS This is a secondary analysis of data from a multicenter randomized controlled trial of elective induction of labor at 39 weeks of gestation in low-risk nulliparous women. In this trial, women completed the Labor Agentry Scale, a validated measure of women's feelings of control over the childbirth process, 6-96 hours after delivery. The Labor Agentry Scale score, which is higher with more perceived control during childbirth, was analyzed both as a continuous and a categorical variable (quintiles). Self-reported breastfeeding at 4-8 weeks postpartum was categorized as exclusive breastfeeding, breastfeeding and formula feeding, or exclusive formula feeding. Women were included in this analysis if they labored, filled out a Labor Agentry Scale questionnaire, had a neonate who survived until the postpartum visit, and provided information on infant feeding. Multinomial logistic regression was used to adjust for confounders. RESULTS Of 5,185 women, 32.9% (n=1,705) were exclusively breastfeeding, 31.2% (n=1,620) were breastfeeding and formula feeding, and 35.9% (n=1,860) were exclusively formula feeding 4-8 weeks after delivery. Overall Labor Agentry Scale score ranged from 34 to 203 (median 167, interquartile range 145-182). The median Labor Agentry Scale score was 169 (interquartile range 151-183) for women exclusively breastfeeding, 166 (interquartile range 142-182) for women who were breastfeeding and formula feeding, and 164 (interquartile range 142-181) for women who were only formula feeding (P<.001). In the unadjusted multinomial model, women with Labor Agentry Scale scores in the lowest two quintiles (ie, those with lower perceived control during childbirth) were less likely to be exclusively breastfeeding (as compared with those exclusively formula feeding) than women in the highest Labor Agentry Scale quintile. When controlling for confounders, however, this association was no longer significant. CONCLUSION After adjustment for confounders, perceived control during childbirth was not associated with breastfeeding at 4-8 weeks postpartum among nulliparous women. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01990612.
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28
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Abuelezam NN, Cuevas AG, Galea S, Hawkins SS. Maternal Health Behaviors and Infant Health Outcomes Among Arab American and Non-Hispanic White Mothers in Massachusetts, 2012-2016. Public Health Rep 2020; 135:658-667. [PMID: 32805192 DOI: 10.1177/0033354920941146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The health profile of Arab American mothers and infants may differ from that of non-Arab American mothers and infants in the United States as a result of social stigma experienced in the historical and current sociopolitical climate. The objective of our study was to compare maternal health behaviors, maternal health outcomes, and infant health outcomes of Arab American mothers and non-Hispanic white mothers in Massachusetts and to assess the role of nativity as an effect modifier. METHODS Using data from Massachusetts birth certificates (2012-2016), we conducted adjusted logistic and linear regression models for maternal health behaviors, maternal health outcomes, and infant health outcomes. We used Arab ethnicity as the exposure of interest and nativity as an effect modifier. RESULTS Arab American mothers had higher odds than non-Hispanic white mothers of initiating breastfeeding (adjusted odds ratio [aOR] = 2.61; 95% CI, 2.39-2.86), giving birth to small-for-gestational-age infants (aOR = 1.28; 95% CI, 1.18-1.39), and having gestational diabetes (aOR = 1.31; 95% CI, 1.20-1.44). Among Arab American mothers, non-US-born mothers had higher odds than US-born mothers of having gestational diabetes (aOR = 1.80; 95% CI, 1.33-2.44) and lower odds of initiating prenatal care in the first trimester (aOR = 0.41; 95% CI, 0.33-0.50). In linear regression models, infants born to non-US-born Arab American mothers weighed 42.1 g (95% CI, -75.8 to -8.4 g) less than infants born to US-born Arab American mothers. CONCLUSION Although Arab American mothers engage in positive health behaviors, non-US-born mothers had poorer maternal health outcomes and access to prenatal care than US-born mothers, suggesting the need for targeted interventions for non-US-born Arab American mothers.
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Affiliation(s)
- Nadia N Abuelezam
- 6019 Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Adolfo G Cuevas
- 1810 Department of Community Health, Tufts University, Medford, MA, USA
| | - Sandro Galea
- 1846 Boston University School of Public Health, Boston, MA, USA
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29
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Hiatt RA, Engmann NJ, Balke K, Rehkopf DH. A Complex Systems Model of Breast Cancer Etiology: The Paradigm II Conceptual Model. Cancer Epidemiol Biomarkers Prev 2020; 29:1720-1730. [PMID: 32641370 DOI: 10.1158/1055-9965.epi-20-0016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/09/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The etiology of breast cancer is a complex system of interacting factors from multiple domains. New knowledge about breast cancer etiology continues to be produced by the research community, and the communication of this knowledge to other researchers, practitioners, decision makers, and the public is a challenge. METHODS We updated the previously published Paradigm model (PMID: 25017248) to create a framework that describes breast cancer etiology in four overlapping domains of biologic, behavioral, environmental, and social determinants. This new Paradigm II conceptual model was part of a larger modeling effort that included input from multiple experts in fields from genetics to sociology, taking a team and transdisciplinary approach to the common problem of describing breast cancer etiology for the population of California women in 2010. Recent literature was reviewed with an emphasis on systematic reviews when available and larger epidemiologic studies when they were not. Environmental chemicals with strong animal data on etiology were also included. RESULTS The resulting model illustrates factors with their strength of association and the quality of the available data. The published evidence supporting each relationship is made available herein, and also in an online dynamic model that allows for manipulation of individual factors leading to breast cancer (https://cbcrp.org/causes/). CONCLUSIONS The Paradigm II model illustrates known etiologic factors in breast cancer, as well as gaps in knowledge and areas where better quality data are needed. IMPACT The Paradigm II model can be a stimulus for further research and for better understanding of breast cancer etiology.
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Affiliation(s)
- Robert A Hiatt
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California. .,Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | | | - Kaya Balke
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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30
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Bellando J, McCorkle G, Spray B, Sims CR, Badger TM, Casey PH, Scott H, Beall SR, Sorensen ST, Andres A. Developmental assessments during the first 5 years of life in infants fed breast milk, cow's milk formula, or soy formula. Food Sci Nutr 2020; 8:3469-3478. [PMID: 32724610 PMCID: PMC7382202 DOI: 10.1002/fsn3.1630] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/03/2020] [Accepted: 04/17/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To investigate the effects of infant feeding mode on childhood cognition and language as the differential effects of infant feeding on development remain understudied. METHODS Breastfed [BF, 174], cow's milk-based formula-fed [MF, 169], or soy protein-based formula-fed [SF, 161] children were longitudinally tested from age 3 to 60 months for neurodevelopment. Data were analyzed using mixed models while adjusting for multiple covariates. Sex differences were also assessed. RESULTS Standard scores were within established norms for all groups. There were no differences in mental development to age 24 months, yet BF children had significantly higher motor development scores at age 3 months than SF children (99.1 versus. 97.2). BF children had significantly higher composite intelligence scores at 48 months than MF and SF children (113.4 versus. 109.6 and 108.4, respectively) and higher verbal intelligence scores than SF children at 48 (105.6 versus. 100.7) and 60 months (109.8 versus. 105.9). Greater total language scores at ages 36 and 48 months were found in BF children compared with children fed MF or SF (p < .001), with differences between sexes for auditory comprehension. Higher total language scores at age 60 months were found between BF and SF (105.0 versus. 100.1). CONCLUSION Breastfeeding was associated with small, statistically significant, differences between children ages 3 and 5 years in verbal intelligence, expressive communication, and auditory comprehension with the latter having potential sexual dimorphic effects. Yet, these differences remain small and may not be of clinical relevance. Overall, MF and SF did not significantly differ.
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Affiliation(s)
- Jayne Bellando
- Arkansas Children's Nutrition CenterLittle RockARUSA
- Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | | | - Beverly Spray
- Arkansas Children's Research InstituteLittle RockARUSA
| | - Clark R. Sims
- Arkansas Children's Nutrition CenterLittle RockARUSA
- Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Thomas M. Badger
- Arkansas Children's Nutrition CenterLittle RockARUSA
- Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Patrick H Casey
- Arkansas Children's Nutrition CenterLittle RockARUSA
- Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Holly Scott
- Arkansas Children's Nutrition CenterLittle RockARUSA
| | | | - Seth T. Sorensen
- Arkansas Children's Nutrition CenterLittle RockARUSA
- Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Aline Andres
- Arkansas Children's Nutrition CenterLittle RockARUSA
- Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockARUSA
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31
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Bader LR, Ward J, Fouts HN, Jaekel J. Infant Care Practices among Resettled Refugee Mothers from East and Central Africa. CHILDREN (BASEL, SWITZERLAND) 2020; 7:children7060063. [PMID: 32560348 PMCID: PMC7346106 DOI: 10.3390/children7060063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/27/2020] [Accepted: 06/13/2020] [Indexed: 11/20/2022]
Abstract
Refugees often parent under extreme circumstances. Parenting practices have implications for child outcomes, and parenting in the context of refugee resettlement is likely to be dynamic as parents negotiate a new culture. This study examined African origin mothers’ infant care values and practices related to feeding, carrying, and daily activities following resettlement in the Southeastern region of the U.S. Ten African origin mothers were asked about their infant care practices through semi-structured interviews. Results indicated that mothers valued breastfeeding but often chose to use formula as a supplement or instead of breastfeeding. In addition, participants valued carrying their infants close to the body but used equipment such as strollers. Mothers expressed that perceptions of American culture and rules, social support, interactions with community agencies, and the need to engage in formal employment were factors that influenced their infant care practices.
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Affiliation(s)
- Lauren R. Bader
- Institute for Advanced Study in Toulouse, University of Toulouse Capitole, 31080 Toulouse CEDEX 06, France;
| | - Jennifer Ward
- Institute of Agriculture, University of Tennessee, Knoxville, TN 37996, USA;
| | - Hillary N. Fouts
- Department of Child & Family Studies, University of Tennessee Knoxville, Knoxville, TN 37996, USA;
| | - Julia Jaekel
- Department of Child & Family Studies, University of Tennessee Knoxville, Knoxville, TN 37996, USA;
- Department of Psychology, University of Tennessee Knoxville, Knoxville, TN 37996, USA
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
- Correspondence:
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Abdulla L, McGowan EC, Tucker RJ, Vohr BR. Disparities in Preterm Infant Emergency Room Utilization and Rehospitalization by Maternal Immigrant Status. J Pediatr 2020; 220:27-33. [PMID: 32111378 DOI: 10.1016/j.jpeds.2020.01.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effects of immigrant mother status and risk factors on the rates of emergency room (ER) visits and rehospitalizations of preterm infants within 90 days after discharge. STUDY DESIGN This was a retrospective cohort study of 732 mothers of 866 preterm infants (<37 weeks of gestational age) cared for in a neonatal intensive care unit (NICU) for >5 days. Medical and demographic data and number of ER visits and rehospitalizations were collected. The primary outcomes were the numbers of ER visits and rehospitalizations. Analysis included bivariate comparisons of immigrant and native mother-infant dyads. Regression models were run to estimate the effects of immigrant mother status and risk factors. RESULTS Compared with native mothers, immigrant mothers (176 of 732; 24%) were more likely to be older, to be gravida >1, to be nonwhite, to have a non-English primary language, to have less than a high school education, and to have Medicaid insurance but less likely to have child protective services, substance abuse, and a mental health disorder. Infants of immigrant mothers (203 of 866; 23%) had higher rates of ER visits and more days of hospitalization compared with infants of native mothers. Among immigrant mothers only, >5 years living in the US, non-English primary language, and bronchopulmonary dysplasia (BPD) were predictive of ER visits, whereas Medicaid and BPD were predictive of rehospitalization. For the total cohort, after an interaction between Medicaid and immigrant status was added to the model, immigrant status became nonsignificant and immigrant mothers with Medicaid emerged as a strong predictor of hospitalization and a borderline predictor for ER visits. CONCLUSIONS Among immigrant mothers, non-English primary language, >5 years living in the US, and BPD increased the odds of an ER visit. For the total cohort, however, the interaction of immigrant mother with Medicaid as a marker of poverty provided a significant modifying effect on increased rehospitalization and ER use.
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Affiliation(s)
- Layla Abdulla
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI
| | - Elisabeth C McGowan
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI; Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI
| | - Richard J Tucker
- Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI
| | - Betty R Vohr
- Division of Biology and Medicine, Undergraduate Program, Brown University, Providence, RI; Division of Neonatology, Women & Infants Hospital of Rhode Island, Providence, RI; Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI.
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Integrating motherhood and employment: A 22-year analysis investigating impacts of US workplace breastfeeding policy. SSM Popul Health 2020; 11:100580. [PMID: 32382650 PMCID: PMC7200309 DOI: 10.1016/j.ssmph.2020.100580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/06/2020] [Accepted: 04/01/2020] [Indexed: 11/21/2022] Open
Abstract
The United States has one of the lowest exclusive breastfeeding rates among high-income countries. Most experts agree that there is a lack of mother-friendly workplace policies compared to other countries. Since 1995, 25 states have implemented workplace breastfeeding legislation allowing mothers to express and store breast milk in the workplace. There is heterogeneity in policy enforceability where 17 states have weak enforceability while eight states have strict enforceability and require employers to offer provisions to breastfeed at the workplace. Using difference-in-differences methods, we examine the impact of this policy on state-level breastfeeding rates and assess how that impact differs with policy enforceability. We use data from the Centers for Disease Control on breastfeeding, supplementing with socio-economic data from the Panel Study of Income Dynamics, Current Population Survey, the US Census Bureau and several other datasets over 22 years from 1990 to 2011. We find that states with legislation experienced a 2.3-percentage point increase in breastfeeding rates compared to states without legislation while states with weak enforceability experienced a 3.1-percentage point increase compared to states without legislation. We also find that policies do not start to have an impact until 1–2 years after they were signed into law. Considering the recent assault on breastfeeding from the current administration, our study is a timely and important contribution that strengthens the evidence base for the health benefits of workplace breastfeeding policies. Some US states have passed workplace breastfeeding policies to allow mothers to pump milk in the workplace. We assess the impact of such policies in the US on breastfeeding rates considering the heterogeneity of the policy. States with workplace breastfeeding policies experienced a 2.3-percentage point increase in breastfeeding rates. The policy impact differed by enforceability of the policy. Workplace breastfeeding policies can be an avenue to help stagnant breastfeeding rates.
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Nguyen VK, Kahana A, Heidt J, Polemi K, Kvasnicka J, Jolliet O, Colacino JA. A comprehensive analysis of racial disparities in chemical biomarker concentrations in United States women, 1999-2014. ENVIRONMENT INTERNATIONAL 2020; 137:105496. [PMID: 32113086 PMCID: PMC7137529 DOI: 10.1016/j.envint.2020.105496] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Stark racial disparities in disease incidence among American women remain a persistent public health challenge. These disparities likely result from complex interactions between genetic, social, lifestyle, and environmental risk factors. The influence of environmental risk factors, such as chemical exposure, however, may be substantial and is poorly understood. OBJECTIVES We quantitatively evaluated chemical-exposure disparities by race/ethnicity, life stage, and time in United States (US) women (n = 38,080) by using biomarker data for 143 chemicals from the National Health and Nutrition Examination Survey (NHANES) 1999-2014. METHODS We applied a series of survey-weighted, generalized linear models using data from the entire NHANES women population along with cycle and age-group stratified subpopulations. The outcome was chemical biomarker concentration, and the main predictor was race/ethnicity with adjustment for age, socioeconomic status, smoking habits, and NHANES cycle. RESULTS Compared to non-Hispanic White women, the highest disparities were observed for non-Hispanic Black, Mexican American, Other Hispanic, and Other Race/Multi-Racial women with higher levels of pesticides and their metabolites, including 2,5-dichlorophenol, o,p'-DDE, beta-hexachlorocyclohexane, and 2,4-dichlorophenol, along with personal care and consumer product compounds, including parabens and monoethyl phthalate, as well as several metals, such as mercury and arsenic. Moreover, for Mexican American, Other Hispanic, and non-Hispanic black women, there were several exposure disparities that persisted across age groups, such as higher 2,4- and 2,5-dichlorophenol concentrations. Exposure levels for methyl and propyl parabens, however, were the highest in non-Hispanic black compared to non-Hispanic white children with average differences exceeding 4-fold. Exposure disparities for methyl and propyl parabens are increasing over time in Other Race/Multi-Racial women while fluctuating for non-Hispanic Black, Mexican American, and Other Hispanic. Cotinine levels are among the highest in Non-Hispanic White women compared to Mexican American and Other Hispanic women with disparities plateauing and increasing, respectively. DISCUSSION We systematically evaluated differences in chemical exposures across women of various race/ethnic groups and across age groups and time. Our findings could help inform chemical prioritization in designing epidemiological and toxicological studies. In addition, they could help guide public health interventions to reduce environmental and health disparities across populations.
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Affiliation(s)
- Vy Kim Nguyen
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Adam Kahana
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Julien Heidt
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Katelyn Polemi
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jacob Kvasnicka
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Olivier Jolliet
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Justin A Colacino
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
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Stevens DR, Taylor SN, Roberts JR, Neelon B, Newman RB, Vena JE, Hunt KJ. Breastfeeding Initiation as Related to the Interaction of Race/Ethnicity and Maternal Diabetes. Breastfeed Med 2019; 14:630-639. [PMID: 31364862 PMCID: PMC6857546 DOI: 10.1089/bfm.2019.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction: The health benefits of breastfeeding for both the mother and her offspring are well established, and breastfeeding may be especially important for mitigating negative health effects of pregnancy complicated by diabetes. Objective: This study sought to examine the association between race/ethnicity, maternal diabetes, and breastfeeding initiation in South Carolina (SC). Materials and Methods: Our study population is comprised of all live, singleton, full-term births in SC delivered January 2004 to December 2016 (292,468 non-Hispanic Whites, 173,158 non-Hispanic Blacks, and 52,174 Hispanics). Generalized estimating equations and an interaction term between race/ethnicity and maternal diabetes status were used to estimate the race/ethnic-specific odds ratio (OR) and 95% confidence intervals (CIs) that a mother with diabetes versus without diabetes initiated breastfeeding. Models were adjusted for maternal and infant sociodemographics (Model 1), additionally for clinical variables and birth outcomes (Model 2), and also for maternal prepregnancy body mass index (BMI) (Model 3). Results: We found statistically significant differences in breastfeeding initiation by race/ethnicity and diabetes status in Model 1. These associations were attenuated and lost significance upon additional adjustment. Non-Hispanic Black mothers with gestational diabetes were significantly more likely to initiate breastfeeding than nondiabetic non-Hispanic Black mothers, even after adjustment for prepregnancy BMI (OR: 1.07 [95% CI 1.02-1.12]). Conclusion: This large, population-based study of all live, singleton, full-term births in SC improves our understanding of how race/ethnicity and maternal metabolic disorders impact breastfeeding initiation, and may inform future hospital-based breastfeeding interventions in populations with the most need.
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Affiliation(s)
- Danielle R Stevens
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - James R Roberts
- Department of Pediatrics and Medical University of South Carolina, Charleston, South Carolina
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
| | - John E Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kelly J Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
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Molitoris J. Breast-feeding During Pregnancy and the Risk of Miscarriage. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:153-163. [PMID: 31524957 PMCID: PMC6856964 DOI: 10.1363/psrh.12120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 05/16/2019] [Accepted: 06/13/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Breast-feeding rates and durations have been increasing among U.S. women in recent decades. As a result, women may be more likely to practice breast-feeding during pregnancy (BDP), which has been hypothesized to increase the risk of miscarriage, yet there has been little research into the issue. METHODS Data on 10,661 pregnancies from several waves of the National Survey of Family Growth, covering the years 2002-2015, were used to calculate unadjusted miscarriage rates according to BDP status. Multivariate Cox proportional hazards models were employed to investigate the association between BDP and the risk of miscarriage. RESULTS BDP was practiced for 6% of the total time at risk of miscarriage. The miscarriage rate was higher when mothers exclusively breast-fed during pregnancy (35%) than when they practiced either complementary BDP (i.e., the child also consumed other food) or did not breast-feed (14% and 15%, respectively). After adjustment for maternal and pregnancy characteristics, the risk of miscarriage was greater when mothers exclusively breast-fed than when mothers did not breast-feed (hazard ratio, 3.9), but no increased risk was found with complementary BDP. The miscarriage risk during exclusive BDP was similar to that for women who conceived when they were 40 or older (3.2). CONCLUSIONS Exclusive BDP is associated with an elevated risk of miscarriage, but it remains unclear whether and how the practice is associated with health outcomes for the mother and breast-fed child. Research is needed to further explore these outcomes to inform recommendations regarding BDP.
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Affiliation(s)
- Joseph Molitoris
- The Centre for Economic Demography, Department of Economic HistoryLund UniversityLundSweden
- The Hungarian Demographic Research InstituteBudapest
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Aghaee S, Deardorff J, Greenspan LC, Quesenberry CP, Kushi LH, Kubo A. Breastfeeding and timing of pubertal onset in girls: a multiethnic population-based prospective cohort study. BMC Pediatr 2019; 19:277. [PMID: 31399074 PMCID: PMC6688234 DOI: 10.1186/s12887-019-1661-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022] Open
Abstract
Background Early puberty is associated with higher risk of adverse health and behavioral outcomes throughout adolescence and adulthood. US girls are experiencing earlier puberty with substantial racial/ethnic differences. We examined the association between breastfeeding and pubertal timing to identify modifiable risk factors of early puberty and potential sources of racial/ethnic differences in the timing of pubertal development. Methods A prospective cohort study of 3331 racially/ethnically diverse girls born at Kaiser Permanente Northern California (KPNC) between 2004 and 06. All data were obtained from KPNC electronic clinical and administrative datasets. Mother-reported duration of breastfeeding was obtained from questionnaires administered at each ‘well-baby’ check-up exam throughout the baby’s first year and categorized as ‘Not breastfed’, ‘Breastfed < 6 months’, and ‘Breastfed ≥ 6 months’. Pubertal development data used Tanner stages assessed by pediatricians during routine pediatric checkups starting at age 6. Pubertal onset was defined as transition from Tanner Stage 1 to Tanner Stage 2+ for breast (thelarche) and pubic hair (pubarche). Weibull regression models accommodating for left, right, and interval censoring were used in all analyses. Models were adjusted for maternal age, education, race/ethnicity, parity and prepubertal body mass index (BMI). We also examined race/ethnicity as a potential effect modifier of these associations. Results Not breastfeeding was associated with earlier onset of breast and pubic hair development compared to breastfeeding ≥6 months (adjusted hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.07–1.46; HR: 1.24; 95% CI: 1.05–1.46, respectively). Breastfeeding for < 6 months was also associated with the risk of earlier pubic hair development (HR: 1.14; 95% CI: 1.00–1.30, compared to breastfeeding ≥6 months). Inclusion of girls’ prepubertal BMI slightly attenuated the association between breastfeeding and timing of breast onset but remained significant. The association between not breastfeeding and early breast development may be stronger among African American girls (HR: 1.92; 95% CI: 1.01–3.66, no breastfeeding vs. ≥6 months) than other racial/ethnic groups. Conclusions Breastfeeding is an independent predictor of pubertal onset in girls, and the strength of the association may vary by race/ethnicity. Providing breastfeeding support and lactation education for high risk mothers may help prevent earlier pubertal onset and promote positive health outcomes later in life.
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Affiliation(s)
- Sara Aghaee
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Julianna Deardorff
- Division of Maternal and Child Health, University of California, Berkeley, School of Public Health, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA
| | - Louise C Greenspan
- Kaiser Permanente San Francisco Medical Center, 2425 Geary Boulevard, San Francisco, CA, 94115, USA
| | | | - Lawrence H Kushi
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Ai Kubo
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
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Whitley MD, Ro A, Choi B. Workplace breastfeeding support and job satisfaction among working mothers in the United States. Am J Ind Med 2019; 62:716-726. [PMID: 31168846 DOI: 10.1002/ajim.22989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Job satisfaction is associated with health and productivity. Workplace support for breastfeeding may affect working mothers' job satisfaction. METHODS We analyzed responses from 488 women from the Infant Feeding Practices Study II (2005-2007). Using logistic regression, we assessed whether workplace breastfeeding problems at 3 months postpartum were related to low job satisfaction concurrently and, for a subsample (n = 265), at 9 and 12 months postpartum. RESULTS Compared with women reporting no problems, women reporting three or more problems had higher odds (odds ratio [OR] = 4.76; 95% confidence interval [CI]: 2.03-11.18) of low job satisfaction at 3 months, and at 12 months (OR = 6.88, 95% CI: 1.33-35.58) after controlling for baseline job satisfaction. Models isolating problems with break time and space to pump/nurse showed more modest results. CONCLUSIONS Work-related breastfeeding problems at 3 months postpartum were associated with low job satisfaction concurrently and at follow-up. Improving workplace breastfeeding accommodations could improve mothers' job satisfaction.
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Affiliation(s)
- Margaret D. Whitley
- Public Health ProgramUniversity of California, IrvineIrvine California
- Behavioral and Policy SciencesRAND CorporationSanta Monica California
| | - Annie Ro
- Public Health ProgramUniversity of California, IrvineIrvine California
| | - BongKyoo Choi
- Department of Medicine and Public Health ProgramUniversity of California, IrvineIrvine California
- Center for Work and Health ResearchIrvine California
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Breastfeeding Practices of Ethnic Minorities in China: A Population-Based Cross-Sectional Study of 10,408 Mothers. J Immigr Minor Health 2019; 22:545-553. [PMID: 31325098 PMCID: PMC7190676 DOI: 10.1007/s10903-019-00918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Heterogeneous characteristics of Chinese ethnic groups and their acculturation might contribute to different breastfeeding patterns. This study aimed to explore the breastfeeding practices of ethnic minorities in China considering migration and acculturation. We included 10,408 mothers from a population-based study in China. Ethnic minority was defined as ethnics other than Han. Logistic regression and adjusted prevalence were employed to analyze the association between ethnicity and breastfeeding outcomes. Both Minority group (where both parents were ethnic minorities) had a higher odds of exclusive breastfeeding and predominant breastfeeding. After stratification, this significantly higher odds of exclusive breastfeeding was solely observed among local mothers (those who never immigrated). Husbands caring for mothers “sitting the month”, which could contribute to exclusive breastfeeding, was more common among local Both Minority group. Parental ethnicities and their acculturation could influence breastfeeding practices in China. Interventions should consider ethnic differences as well as acculturation.
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Dixit A, Miner EM, Wiehe SE, McHenry MS. Adolescent Burmese Refugees Perspectives on Determinants of Health. J Immigr Minor Health 2019; 20:370-379. [PMID: 28825219 DOI: 10.1007/s10903-017-0648-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Over 70,000 Burmese refugees have resettled in the United States in the past decade. While Burmese adolescents quickly acculturate into American society, their perspectives on health are not well-known. The purpose of this study was to identify adolescent Burmese refugee perspectives on determinants of health and health-related experiences after resettlement. In this qualitative study, Burmese adolescents took photographs depicting health-related experiences that were used as elicitation tools during focus groups. These discussions were recorded, transcribed, and analyzed for themes. Participants described positive determinants of health, including family and church. Rampant tobacco use was identified by the participants as a determinant of poor health within the Burmese community. Notably, the participants were proud to serve as liaisons within their community, despite the stressful nature of this role. Our results highlight the need to screen this population for anxiety, secondary to serving as a liaison for their community, as well as tobacco use.
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Affiliation(s)
- Avika Dixit
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Emily M Miner
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Sarah E Wiehe
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, HS2000, Indianapolis, IN, 46202, USA
| | - Megan S McHenry
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th St, HS2000, Indianapolis, IN, 46202, USA.
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Dennis CL, Shiri R, Brown HK, Santos HP, Schmied V, Falah-Hassani K. Breastfeeding rates in immigrant and non-immigrant women: A systematic review and meta-analysis. MATERNAL AND CHILD NUTRITION 2019; 15:e12809. [PMID: 30884175 DOI: 10.1111/mcn.12809] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
Breastfeeding benefits mothers and infants. Although immigration in many regions has increased in the last three decades, it is unknown whether immigrant women have better breastfeeding outcomes than non-immigrants. The aim of this study was to conduct a systematic review and meta-analysis to determine whether breastfeeding rates differ between immigrant and non-immigrant women. We searched Medline, Embase, PsycINFO, CINAHL and Google Scholar, 1950 to 2016. We included peer-reviewed cross-sectional and cohort studies of women aged ≥16 years that assessed and compared breastfeeding rates in immigrant and non-immigrant women. Two independent reviewers extracted data using predefined standard procedures. The analysis included 29 studies representing 1,539,659 women from 14 countries. Immigrant women were more likely than non-immigrants to initiate any (exclusive or partial) breastfeeding (pooled adjusted prevalence ratio 1.13, 95% confidence interval [CI] 1.07-1.19; 11 studies). Exclusive breastfeeding initiation was higher but borderline significant (adjusted prevalence ratio 1.20, 95% CI 1.00-1.45; 5 studies, p = 0.056). Immigrant women were more likely than non-immigrants to continue any breastfeeding between 12- and 24-week postpartum (pooled adjusted risk ratio 2.04, 95% CI 1.79-2.32; 3 studies) and > 24 weeks (adjusted risk ratio 1.33, 95% CI 1.02-1.73; 6 studies) but not exclusive breastfeeding. Immigrant women are more likely than non-immigrants to initiate and maintain any breastfeeding, but exclusive breastfeeding remains a challenge for both immigrants and non-immigrants. Social and cultural factors need to be considered to understand the extent to which immigrant status is an independent predictor of positive breastfeeding practices.
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Affiliation(s)
- Cindy-Lee Dennis
- Faculty of Nursing, University of Toronto, Toronto, Canada.,St. Michael's Hospital, Toronto, Canada
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Hilary K Brown
- Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Hudson P Santos
- School of Nursing, University of North Carolina, Chapel Hill, USA
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Bigman G, Wilkinson AV, Pérez A, Homedes N. Acculturation and Breastfeeding Among Hispanic American Women: A Systematic Review. Matern Child Health J 2019; 22:1260-1277. [PMID: 30003522 DOI: 10.1007/s10995-018-2584-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction Hispanic immigrants are more likely to breastfeed than are Hispanics born in the US, in part due to their acculturation. This paper aims to systematically review the existing literature on the association between acculturation and Hispanics' breastfeeding behaviors. Methods The systematic search used major databases such as Medline and PubMed, and it followed the PRISMA checklist. The scientific quality of the studies was rated using the Quality Assessment Tool for Quantitative Studies. Results We identified 1943 potential citations, of which 18 studies met the eligibility criteria. Overall, while 13 studies suggested that high-acculturated Hispanics were less likely to breastfeed compared with low-acculturated, five studies did not find significant evidence of such an association. Moreover, 12 studies used a static measure or a linear scale, which is not optimal; only three studies utilized bi/multidimensional scales to assess acculturation. Intention to breastfeed was examined in six studies, but the results were inconsistent. Breastfeeding initiation was examined in 11 studies, and two out of eight studies that examined breastfeeding duration, specifically analyzed exclusive breastfeeding at 6 months. Discussion Our results agree with the general hypothesis that higher acculturation is inversely related to breastfeeding rates, independently of income. Researchers used different methodologies to study acculturation and breastfeeding practices, limiting our ability to reach more detailed conclusions. Owing to the lack of a standard methodology for measuring acculturation, future studies should utilize bi/multidimensional scales when studying breastfeeding, in particular, in relation to breastfeeding intention and exclusive breastfeeding at 6 months; preferably according to Hispanic subgroups.
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Affiliation(s)
- Galya Bigman
- Epidemiology, Human Genetics and Environmental Sciences, School of Public Health - Austin Regional Campus, The University of Texas Health Science Center at Houston, 1616 Guadalupe, Austin, TX, 78701, USA.
| | - Anna V Wilkinson
- Epidemiology, Human Genetics and Environmental Sciences, School of Public Health - Austin Regional Campus, The University of Texas Health Science Center at Houston, 1616 Guadalupe, Austin, TX, 78701, USA
| | - Adriana Pérez
- Biostatistics and Data Science, School of Public Health - Austin Regional Campus, The University of Texas Health Science Center at Houston, 1616 Guadalupe, Austin, TX, 78701, USA
| | - Nuria Homedes
- Management Policy and Community Health, School of Public Health, University of Texas, El Paso, TX, USA
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Wallenborn JT, Chambers GJ, Scialli A, Orekoya O, Masho SW. Interracial couples and breastfeeding initiation in the United States. Prev Med 2019; 120:140-143. [PMID: 30685317 DOI: 10.1016/j.ypmed.2019.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/10/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
In the past decade, the prevalence of interracial couples has steadily increased. Recent reports state that nearly one in five marriages are between spouses of different races. Interracial couples receive less social support and are more likely to separate. As a result, children born to these couples may be at an increased risk of poor health outcomes. This study aims to investigate the relationship between interracial couples and breastfeeding initiation. Data from the 2014 Vital Statistics Natality Birth database were analyzed. Data were restricted to singleton births and infants with no congenital malformations. Racial composition of parents was categorized as non-Hispanic (NH) white, NH black; Hispanic; NH white/NH black; NH white/Hispanic; and NH black/Hispanic. Breastfeeding initiation (yes; no) was categorized according to information from the child's birth certificate file. Multiple logistic regression was used to generate crude and adjusted odds ratios and 99% confidence intervals. After adjusting for confounders, all interracial couples with at least one Hispanic parent had increased odds of breastfeeding initiation. Interracial white and black parents had 18% lower odds of breastfeeding initiation. The lowest odds of breastfeeding initiation were observed among intraracial black parents, who had 43% lower odds of breastfeeding initiation compared to intraracial white parents. Breastfeeding non-initiation continues to pose the greatest risk for infants with at least one black parent. Nurses, midwives, physicians, and other medical staff should discuss potential barriers that may be unique to interracial couples and provide additional breastfeeding education and support.
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Affiliation(s)
- Jordyn T Wallenborn
- Virginia Commonwealth University, School of Medicine, Division of Epidemiology, Department of Family Medicine and Population Health, 830 East Main Street, Suite 821, P.O. Box 980212, Richmond, VA, United States.
| | - Gregory J Chambers
- Virginia Commonwealth University, School of Medicine, Division of Epidemiology, Department of Family Medicine and Population Health, 830 East Main Street, Suite 821, P.O. Box 980212, Richmond, VA, United States.
| | - Anna Scialli
- Virginia Commonwealth University, School of Medicine, Division of Epidemiology, Department of Family Medicine and Population Health, 830 East Main Street, Suite 821, P.O. Box 980212, Richmond, VA, United States.
| | - Olubunmi Orekoya
- Virginia Commonwealth University, School of Medicine, Division of Epidemiology, Department of Family Medicine and Population Health, 830 East Main Street, Suite 821, P.O. Box 980212, Richmond, VA, United States.
| | - Saba W Masho
- Virginia Commonwealth University, School of Medicine, Division of Epidemiology, Department of Family Medicine and Population Health, 830 East Main Street, Suite 821, P.O. Box 980212, Richmond, VA, United States.
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Sebastian RA, Coronado E, Otero MD, McKinney CR, Ramos MM. Associations Between Maternity Care Practices and 2-Month Breastfeeding Duration Vary by Race, Ethnicity, and Acculturation. Matern Child Health J 2019; 23:858-867. [PMID: 30659460 DOI: 10.1007/s10995-018-02711-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives This study examines the associations between specific maternity care practices and breastfeeding duration for Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White women. Methods We analyzed data from the 2012-2014 New Mexico Pregnancy Risk Assessment Monitoring System. We used survey language as a proxy measure of acculturation and categorized women as Spanish-speaking Hispanic, English-speaking Hispanic, non-Hispanic Native American, and non-Hispanic White. We conducted bivariate analyses to compare rates of breastfeeding at 2 months and experiences of maternity care practices and logistic regression analysis to estimate the effects of these practices on breastfeeding duration for each group. Results Hispanic women were less likely than non-Hispanic women to breastfeed for at least 2 months (67.9% vs. 76.6%; p = 0.000); however, this varied significantly by acculturation level: 78.1% of Spanish-speaking Hispanic women compared to 66.1% of English-speaking Hispanic women breastfed for at least 2 months (p = 0.000). The effects of specific maternity care practices on duration varied across groups. Among non-Hispanic White, Native American, and English-speaking Hispanic women, breastfeeding while at the hospital had the strongest effect (AOR 2.09, 95% CI 1.67-2.61; AOR 2.71, 95% CI 2.08-3.52; and AOR 1.99, 95% CI 1.76-2.25, respectively). Among Spanish-speaking Hispanic women, being encouraged to breastfeed on demand had the strongest effect (AOR 5.179, 95% CI 3.86-6.94). Conclusions for Practice The effects of maternity care practices on breastfeeding duration vary by race, ethnicity, and acculturation level. Health care systems must acknowledge the diversity of their patient populations when seeking to develop and implement breastfeeding-friendly practices.
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Affiliation(s)
- Rachel A Sebastian
- Child Policy Research Consulting, LLC, 124 Basswood Circle, Fort Wright, KY, 41011, USA.
| | - Eirian Coronado
- New Mexico Department of Health, 1190 S. St. Francis Drive, Santa Fe, NM, 87505, USA
| | - Maria D Otero
- Nuestra Salud, LLC, 4282 Alexander Blvd NE, Albuquerque, NM, 87107, USA
| | - Courtney R McKinney
- Department of Pediatrics, University of New Mexico School of Medicine, 625 Silver Avenue SW, Suite 324, Albuquerque, NM, 87102, USA
| | - Mary M Ramos
- Division of Adolescent Medicine, Department of Pediatrics, University of New Mexico School of Medicine, MSC 10 5590, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
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Parker MG, Lopera AM, Kalluri NS, Kistin CJ. "I Felt Like I Was a Part of Trying to Keep My Baby Alive": Perspectives of Hispanic and Non-Hispanic Black Mothers in Providing Milk for Their Very Preterm Infants. Breastfeed Med 2018; 13:657-665. [PMID: 30299981 DOI: 10.1089/bfm.2018.0104] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Compared with non-Hispanic white, Hispanic and non-Hispanic black mothers of very preterm infants are less likely to provide mother's milk at the point of hospital discharge; the perspectives of these mothers are poorly understood. Objectives: To examine the perceived barriers and facilitators of providing milk for very preterm infants during the hospitalization among Hispanic and non-Hispanic black mothers. Materials and Methods: We conducted 23 in-depth, semistructured interviews of English and Spanish-speaking Hispanic and non-Hispanic black mothers that initiated milk production for their very preterm infants, ≤1,750 g at birth. Following thematic saturation, results were validated through expert triangulation and member checking. Results: Twelve mothers were Hispanic, where three were English speaking and nine were Spanish speaking. Eleven mothers were non-Hispanic black and English speaking. We found themes pertaining to general experiences: (1) Breastfeeding intent impacts mothers' success in providing milk throughout the hospitalization; (2) Pumping milk for a hospitalized infant is repetitive, exhausting, and does not elicit the same emotional connection as breastfeeding; (3) Hospital providers are an important source of support, when sufficient time is spent to address ongoing issues; (4) Providing milk creates a unique sense of purpose when mothers otherwise feel a lack of control; and we found themes pertaining to the experiences of Hispanic and non-Hispanic black mothers: (1) Breastfeeding as a cultural norm influences mothers' intent to initiate and continue breastfeeding; (2) Hospital staff are viewed as more supportive when interactions and treatment are perceived as racially/ethnically unbiased and (3) when communication occurs in the primary language; and (4) Mother-infant separation creates logistical challenges that negatively impact ongoing milk production. Conclusions: While providing milk for a hospitalized very preterm infant is exhausting, and logistically challenging, Hispanic and non-Hispanic black mothers are inspired to do so because of their intent to breastfeed, support from hospital providers, and feelings of purpose.
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Affiliation(s)
- Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Adriana M Lopera
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Nikita S Kalluri
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Caroline J Kistin
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Pineros-Leano M, Tabb KM, Simonovich SD, Wang Y, Meline B, Huang H. Racial Differences in Breastfeeding Initiation Among Participants in a Midwestern Public Health District. Health Equity 2018; 2:296-303. [PMID: 30364880 PMCID: PMC6198273 DOI: 10.1089/heq.2018.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Although variations in breastfeeding initiation are well documented, the contributing role of maternal race remains poorly understood, especially among the multiracial—two or more races—population. The purpose of this study is to examine differences in breastfeeding initiation among a racially and ethnically diverse population of low-income women. Methods: Participants for this study (n=1010) were enrolled in the supplemental nutrition program for women, infant, and children and concurrently enrolled in a perinatal depression registry at a public health clinic in the Midwest. Race was obtained from medical records. Breastfeeding initiation was gathered through a clinical interview during the first postpartum visit. Logistic regression was conducted using STATA 14.2. Results: Sixty-eight percent of study participants reported breastfeeding initiation. The bivariate analysis demonstrated that there were significant differences in rates of breastfeeding initiation by race/ethnicity. The logistic regression models showed that after adjusting for maternal education, age, income, nativity, parity, body mass index, and antenatal smoking, Black (odds ratio [OR] 0.47; confidence interval [95% CI] 0.34–0.66), multiracial (OR 0.21; 95% CI 0.07–0.65), and Latina women (OR 0.48; 95% CI 0.26–0.86) were significantly less likely to initiate breastfeeding compared with White women. Conclusion: These findings highlight the need for further understanding of the underlying barriers to the initiation of breastfeeding among low-income Black, multiracial, and Latina women. Moreover, breastfeeding should remain a priority for intervention and policy development, particularly among racially and ethnically diverse low-income women.
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Affiliation(s)
- Maria Pineros-Leano
- School of Social Work, Boston College, Chestnut Hill, Massachusetts.,IDEA Research Team, University of Illinois, Urbana, Illinois
| | - Karen M Tabb
- IDEA Research Team, University of Illinois, Urbana, Illinois.,School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Shannon D Simonovich
- IDEA Research Team, University of Illinois, Urbana, Illinois.,School of Nursing, College of Science & Health, DePaul University, Chicago, Illinois
| | - Yang Wang
- IDEA Research Team, University of Illinois, Urbana, Illinois.,School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Brandon Meline
- IDEA Research Team, University of Illinois, Urbana, Illinois.,Maternal and Child Health Division, Champaign-Urbana Public Health District, Champaign, Illinois
| | - Hsiang Huang
- IDEA Research Team, University of Illinois, Urbana, Illinois.,Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
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SEX DIFFERENCES IN THE SOCIAL ECOLOGY OF BREASTFEEDING: A MIXED METHODS ANALYSIS OF THE BREASTFEEDING VIEWS OF EXPECTANT MOTHERS AND FATHERS IN THE US EXPOSED TO ADVERSITY. J Biosoc Sci 2018; 51:374-393. [PMID: 30350763 DOI: 10.1017/s002193201800024x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite the significant health benefits of breastfeeding for the mother and the infant, economic class and race disparities in breastfeeding rates persist. Support for breastfeeding from the father of the infant is associated with higher rates of breastfeeding initiation. However, little is known about the factors that may promote or deter father support of breastfeeding, especially in fathers exposed to contextual adversity such as poverty and violence. Using a mixed methods approach, the primary aims of the current work were to (1) elicit, using qualitative methodology, the worries, barriers and promotive factors for breastfeeding that expectant mothers and fathers identify as they prepare to parent a new infant, and (2) to examine factors that influence the parental breastfeeding intentions of both mothers and fathers using quantitative methodology. A sample (N=95) of expectant, third trimester mothers and fathers living in a low-income, urban environment in Midwestern USA, were interviewed from October 2013 to February 2015 about their infant feeding intentions. Compared with fathers, mothers more often identified the benefits of breastfeeding for the infant's health and the economic advantage of breastfeeding. Mothers also identified more personal and community breastfeeding support resources. Fathers viewed their own support of breastfeeding as important but expressed a lack of knowledge about the breastfeeding process and often excluded themselves from discussions about infant feeding. The results point to important targets for interventions that aim to increase breastfeeding initiation rates in vulnerable populations in the US by increasing father support for breastfeeding.
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Chai Y, Nandi A, Heymann J. Does extending the duration of legislated paid maternity leave improve breastfeeding practices? Evidence from 38 low-income and middle-income countries. BMJ Glob Health 2018; 3:e001032. [PMID: 30364395 PMCID: PMC6195155 DOI: 10.1136/bmjgh-2018-001032] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction Among all barriers to breastfeeding, the need to work has been cited as one of the top reasons for not breastfeeding overall and for early weaning among mothers who seek to breastfeed. We aimed to examine whether extending the duration of paid maternity leave available to new mothers affected early initiation of breastfeeding, exclusive breastfeeding under 6 months and breastfeeding duration in low-income and middle-income countries (LMICs). Methods We merged longitudinal data measuring national maternity leave policies with information on breastfeeding related to 992 419 live births occurring between 1996 and 2014 in 38 LMICs that participated in the Demographic and Health Surveys. We used a difference-in-differences approach to compare changes in the prevalence of early initiation and exclusive breastfeeding, as well as the duration of breastfeeding, among treated countries that lengthened their paid maternity leave policy between 1995 and 2013 versus control countries that did not. Regression models included country and year fixed effects, as well as measured individual-level, household-level and country-level covariates. All models incorporated robust SEs and respondent-level sampling weights. Results A 1-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage point increase (95% CI 3.2 to 11.7) in the prevalence of early initiation of breastfeeding, a 5.9 percentage point increase (95% CI 2.0 to 9.8) in the prevalence of exclusive breastfeeding and a 2.2- month increase (95% CI 1.1 to 3.4) in breastfeeding duration. Conclusion Extending the duration of legislated paid maternity leave appears to promote breastfeeding practices in LMICs. Our findings suggest a potential mechanism to reduce barriers to breastfeeding for working mothers.
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Affiliation(s)
- Yan Chai
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health and Institute for Health and Social Policy, MGill University, Montreal, Quebec, Canada
| | - Jody Heymann
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
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49
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Dennis CL, Brown HK, Chung-Lee L, Abbass-Dick J, Shorey S, Marini F, Brennenstuhl S. Prevalence and predictors of exclusive breastfeeding among immigrant and Canadian-born Chinese women. MATERNAL AND CHILD NUTRITION 2018; 15:e12687. [PMID: 30194811 DOI: 10.1111/mcn.12687] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/26/2018] [Accepted: 08/23/2018] [Indexed: 01/07/2023]
Abstract
Breastfeeding is the optimal method for infant feeding, yet migrant women may be at risk for suboptimal exclusivity rates. In a cohort of immigrant and Canadian-born Chinese women, our objectives were to (a) describe patterns and prevalence of exclusive breastfeeding at 1, 3, and 6 months postpartum; (b) identify risk and protective factors associated with exclusivity; and (c) examine potentially differential importance of these factors across this 6-month period. This was a prospective study of 565 immigrants and Canadian-born Chinese women (Toronto, Canada). Exclusive breastfeeding was measured at 1, 3, and 6 months postpartum. Predictors comprised fixed (demographics, history of depression, immigrant status, prenatal breastfeeding classes, in-hospital formula supplementation, baseline social support, and baseline acculturative stress) and time-dependent (depression, anxiety, fatigue, and breastfeeding problems) variables. Descriptive statistics, logistic regression, and generalized linear mixed models, respectively, were undertaken to address the objectives. Patterns of breastfeeding practices included exclusive breastfeeding in all time points (26.8%) or none (32.9%) and moving from exclusive to nonexclusive (20.3%) or nonexclusive to exclusive breastfeeding (15.2%). Women less likely to breastfeed exclusively at 1, 3, or 6 months were those whose infants received in-hospital formula supplementation. Exclusivity attrition was higher between 3 and 6 months than 1-3 months. Immigrant status and in-hospital formula supplementation had a significant impact on exclusivity earlier in the postpartum period while breastfeeding problems were associated with decreased exclusivity across time. Proactive preventive efforts are need to maintain breastfeeding exclusivity especially between 3 and 6 months if women are to meet international breastfeeding recommendations.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Interdiscipinary Centre for Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Jennifer Abbass-Dick
- Faculty of Health Sciences, University of Ontario Institute of Technology, Toronto, Ontario, Canada
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Flavia Marini
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Abstract
PURPOSE OF THE REVIEW As the science of the microbiome advances, social epidemiologists can contribute to understanding how the broader social environment shapes the microbiome over the life course. This review summarizes current research and describes potential mechanisms of the social epidemiology of the microbiome. RECENT FINDINGS Most existing literature linking the social environment and the microbiome comes from animal models, focused on the impact of social interactions and psychosocial stress. Suggestive evidence of the importance of early life exposures, health behaviors, and the built environment also point to the importance of the social environment for the microbiome in humans. SUMMARY Social epidemiology as a field is well poised to contribute expertise in theory and measurement of the broader social environment to this new area, and to consider both the upstream and downstream mechanisms by which this environment gets "under the skin" and "into the gut." As population-level microbiome data becomes increasingly available, we encourage investigation of the multi-level determinants of the microbiome and how the microbiome may link the social environment and health.
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Affiliation(s)
- Jennifer Beam Dowd
- Department of Global Health and Social Medicine, King’s College London, The Strand, London, WC2R 2LS UK
- Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY 10027 USA
| | - Audrey Renson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
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